# Mindfulness-based ecological momentary intervention for smoking cessation to address cancer-related relapse risk factors: Intervention development and usability findings

## TL;DR

A smartphone app using mindfulness and real-time support was developed to help cancer survivors quit smoking, showing promising usability and acceptability in early trials.

## Contribution

A novel smartphone app integrating mindfulness and ecological momentary interventions for smoking cessation in cancer survivors was developed and tested.

## Key findings

- Participants found mindfulness and real-time interventions helpful for managing cravings and cancer-related stress.
- The app was reported as highly usable and acceptable by participants in a 4-week pilot trial.
- Adjusting notification timing was suggested as a key improvement for the app.

## Abstract

Despite significant potential adverse health outcomes, many cancer survivors continue smoking. Few smoking cessation interventions have demonstrated efficacy above standard treatment for this population. Through a rigorous iterative process, we developed a prototype smartphone app that addresses both general and cancer-specific relapse risks in real time, incorporating cancer survivors’ feedback. We report findings from two studies: (1) Qualitative interviews and brief surveys to inform intervention development and (2) Usability testing of the prototype app in a 4-week single-arm pilot trial.

Cancer survivors (Study 1: n = 20; Study 2: n = 12) who had smoked at least one cigarette within the past 30 days were enrolled. Study 1 participants completed a 50-minute Zoom interview and survey to inform intervention content and the app design. Subsequently, a prototype app was developed and tested for usability in Study 2, which included ecological momentary interventions (EMIs), three telehealth counseling sessions, and nicotine patches. Baseline and end-of-treatment (EOT) surveys and interviews were completed.

Key findings in Study 1 included high perceived helpfulness of mindfulness and EMIs for managing cravings and cancer-related stress, and a reported strong willingness to use the app. In Study 2, eleven participants used the app and completed counseling sessions. Participants reported high treatment acceptability, app usability, and ease of use. A key suggested improvement was adjusting the timing of app notifications.

Results support continued investigation of this app. Next steps include testing the feasibility and acceptability of the app for smoking cessation.

Study 2 is registered in ClinicalTrials.gov (NCT06476548).