An Evaluation of the Process and Quality Improvement Measures of the University of Virginia Cancer Center Tobacco Treatment Program

Abstract

Tobacco use after a cancer diagnosis can increase risk of disease recurrence, increase the likelihood of a second primary cancer, and negatively impact treatment efficacy. The implementation of system-wide comprehensive tobacco cessation in the oncology setting has historically been low, with over half of cancer clinicians reporting that they do not treat or provide a referral to cessation resources. This quality improvement study evaluated the procedures for assessing and documenting tobacco use among cancer survivors and referring current smokers to cessation resources at the University of Virginia Cancer Center. Process mapping revealed 20 gaps across two major domains: electronic health record (EHR), and personnel barriers. The top identified priority was inconsistent documentation of tobacco use status as it impacted several downstream gaps. Eleven of the 20 gaps were deemed a high priority, and all were addressed during the implementation of the resulting Tobacco Treatment Program. Prioritized gaps were addressed using a combination of provider training, modifications to clinical workflow, and EHR modifications. Since implementation of solutions, the number of unique survivors receiving cessation treatment has increased from 284 survivors receiving cessation support during Year 1 of the initiative to 487 in Year 3. The resulting Tobacco Treatment Program provides a systematic, personalized, and sustainable comprehensive cessation program that optimizes the multifaceted workflow of the Cancer Center and has the potential to reduce tobacco use in a population most in need of cessation support.

Achieving Equity in the Reach of Smoking Cessation Services Within the NCI Cancer Moonshot-Funded Cancer Center Cessation Initiative

“… 29 , 30 Internal quality improvement initiatives can identify multilevel barriers in the process of identifying and referring smokers to cessation treatment, and may help identify gaps in care. 31 Provider-level barriers, including perceived time constraints to providing counseling, inadequate training or skills, or perceptions that cessation counseling is not efficacious may remain a barrier to reaching patients who smoke in some cancer care settings. 27 , 32 Provider training and education, and audit and feedback measures have been shown to improve the reach of smoking cessation programs in cancer care, and implementation of these strategies could help achieve equity in reach.…”

Mixed-methods Economic Evaluation of the Implementation of Tobacco Treatment Programs in National Cancer Institute-designated Cancer Centers

“…Also, behavioral factors in individual health professionals, such as clinical inertia and persistent routine behaviors, may inhibit change. Therefore, implementation of tobacco treatment programs as evidence-based, cost-effective practices does not follow automatically, as there are barriers for change at multiple levels that must be addressed [50][51][52].…”

Mixed-methods Economic Evaluation of the Implementation of Tobacco Treatment Programs in National Cancer Institute-designated Cancer Centers

“…Also, behavioral factors in individual health professionals, such as clinical inertia and persistent routine behaviors, may inhibit change. Therefore, implementation of tobacco treatment programs as evidence-based, cost-effective practices does not follow automatically, as there are barriers for change at multiple levels that must be addressed [50][51][52].…”