Clinical guidance for e-cigarette (vaping) cessation: Results from a modified Delphi panel approach

Abstract

Individuals seek help to stop their use of e-cigarettes from their healthcare practitioners. However, there is a paucity of published work addressing e-cigarette cessation methods empirically, and what evidence that is available is weak. Therefore, we developed an expert informed clinical resource to guide practitioners helping their clients quit using e-cigarettes. We conducted a modified Delphi process between September and December 2021 to reach consensus on clinical recommendations for e-cigarette cessation. Expert and Peer Panel members (n = 28) voted and provided feedback on the recommendations through three rounds of structured surveys, a discussion board, and one intermediate survey. The penultimate knowledge products underwent usability testing and were finalized based on user feedback. The Expert Panel maintained a 100% response rate for rounds 1 and 2 and 96% for round 3; the Peer Panel achieved a 100% response rate for all three rounds of the modified Delphi process. Consensus was reach on 24 recommendations and 2 statements spanning eight domains: severity and dependence; general approaches; treatment approaches; dual use; pharmacotherapy strategies; behavioural therapy strategies; harm reduction; and relapse prevention. Two additional 'no agreement' statements that did not reach consensus are included in the guidance resource. The recommendations were also contextualized for the following groups: adults; youth; people who are pregnant, breastfeeding and/or chestfeeding; and people with mental illness and/or substance use issues. The recommendations listed in the resource provide general clinical guidance on e-cigarette cessation to assist healthcare practitioners in the treatment planning process.

Keywords: Addiction medicine; Combustible tobacco; Delphi; Dual use; E-cigarette; Guidance; Smoking; Vaping; Vaping cessation.

Fig. 1

Flowcharts comparing the traditional and modified Delphi Methodology.

Fig. 2

A flowchart illustrating the results of the modified Delphi Expert Panel. ⁱ All 5 recommendations that were modified and accepted had minor wording modifications made. ⁱⁱ Of the 37 recommendations that did not reach consensus, 1 was split due to different topics, 5 were combined by term (pregnant and breastfeeding) , 2 were combined by population and 2 were combined by vaping/smoking status. ⁱⁱⁱ Of the 16 recommendations that were modified and accepted, 2 were combined due to similar topics and 14 had minor wording modifications made. ^iv These statements were developed based on the results from the intermediate terminology survey and Expert feedback from Round 2. ^v All 9 recommendations that were modified and accepted had minor wording modifications made. ^vi The wording of these 2 statements included in the final resource was not voted on. ^vii Of the 34 recommendations voted on, 1 was combined due to similar topics and 9 were combined by population leaving a combined total of 24 recommendations in the final resource.

Fig. 3

A flowchart illustrating the results of the modified Delphi Peer Panel. ⁱ All 4 recommendations that were modified and accepted had minor wording modifications made. ⁱⁱ Of the 10 recommendations that did not reach consensus, 1 recommendation was combined based on population and 1 was combined based on formatting. ⁱⁱⁱ Of the 8 recommendations that were modified and accepted, 6 minor wording modifications made and 2 were combined by population. ^iv Both recommendations that were modified and accepted had minor wording modifications made. ^v Of the 17 recommendations voted on, 2 were combined based on population leaving a total of 15 recommendations. At the end of Round 3, the accepted recommendations in both the Expert and Peer Panels were combined into one resource.