CONTEXT
cancer, non-White
CANCER


Are nudges informed by behavioral economics during oncology encounters with patients with cancer effective for increasing engagement in tobacco use treatment (TUT)?
Clinician nudges aimed at counteracting omission bias and delivered via the electronic health record resulted in a significant (>3-fold) increase in TUT engagement. The addition of a patient nudge did not affect TUTS engagement rates. Among clinicians, advanced practice providers were more likely than physicians to engage in TUT. White and non-White patients were equally engaged in TUT by the clinician nudge.
Clinician-focused nudges can provide important and timely cues to action that result in more patients engaging in TUT. Such nudges may be a low-cost, low-risk way to optimize use of tobacco cessation services during clinical encounters.**Relevance section written by Despite the importance of TUT, only half of the cancer centers consistently identify patient tobacco use,Implementation efforts to promote TUT engagement within oncology may be enhanced using behavioral economics, which has helped improve patient outcomes and transform health care delivery across a wide range of activities.We designed this pragmatic trial to test the effectiveness of patient- and clinician-directed implementation strategies, or nudges, informed by behavioral economics and delivered through the EHR, to counteract heuristics that reduce the likelihood of engaging in TUT. We compared the effects of nudges directed at patients, clinicians, or both to usual care on rates of TUT. We also performed a preliminary examination of patient and clinician characteristics that may moderate the impact of nudges on rates of TUT, including characteristics that may have important implications for health and social inequities, such as patient age, sex, race/ethnicity, and neighborhood-level SES.