Qualitative Evaluation of a Novel Dialectical Behavior Therapy Brief Intervention for Cigarette Smoking by Patients with Cancer

Introduction: Despite evidence that quitting smoking improves cancer treatment and outcomes, about one in eight patients with cancer smokes cigarettes. The standard of care tobacco treatment, behavioral counseling and medication, may not effectively address their psychosocial barriers to quitting, such as psychological distress and emotion dysregulation related to cancer diagnosis and treatment. This qualitative study evaluated our novel intervention to improve cessation self-efficacy by teaching patients skills in emotion regulation, distress tolerance, and mindfulness. We adapted our virtual, eight-session group intervention from Dialectical Behavior Therapy Skills Training (DBT ST). As a brief intervention, DBT ST has been successfully applied to treat similar conditions, enhancing coping skills and improving outcomes for patients with substance use disorders and patients with breast cancer. DBT ST has not yet been applied to address smoking cessation in cancer populations. Methods: We conducted qualitative interviews with eight patient participants with cancer who smoked or had quit and nine provider participants: oncologists, psychotherapists, and nurses. Interviews were analyzed using thematic analysis. Results: Patients and providers strongly supported the intervention, notably the group format and DBT ST skills for being more present, managing emotions, and handling stress, while sharing mixed opinions on other components, such as its virtual setting and time commitment. Other perceived benefits were improved quality of life, enhanced social support, decreased anxiety and depression, and acquisition of universal skills for managing life challenges. Conclusions: These qualitative results indicate early enthusiasm and promise for our DBT ST brief intervention, suggesting its potential for further development for patients with cancer who smoke cigarettes.