Building Systems to Address Tobacco Use in Oncology: Early Benefits and Opportunities From the Cancer Center Cessation Initiative

Jenssen, Brian P.; Leone, Frank T.; Evers-Casey, Sarah; Beidas, Rinad S.; Schnoll, Robert A.

doi:10.6004/jnccn.2019.7312

Cited by 16 publications

(20 citation statements)

References 10 publications

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“…Tablets in the clinics to enable patients to complete screeners while waiting for appointments may also assist with completion rates and are being considered in the Lurie Cancer Center. While we observed an estimated low smoking prevalence (3.6%), this is comparable to other studies of cancer patients of NCI-designated cancer centers [32,33]. The low smoking prevalence may also be associated with the sociodemographic characteristics of our cancer patient population (e.g., middle to high socioeconomic status).…”

Section: Discussionsupporting

confidence: 83%

“…Initial results from the C3I centers, including the current preliminary study by our center, show major gains in establishing integrated tobacco cessation programs and reaching and treating smokers with cancer [30][31][32][33][34][35][36][37]. These studies have also identified key leverage points, including workflow efficiency and leadership and stakeholder support of implementation [35] and EHR system modifications to facilitate tobacco use assessment and treatment referral and delivery [33,34,36]. Areas in need of further improvement, such as increasing reach to racial and ethnic minorities to address disparities in cancer-related burden, have also been identified [31].…”

Section: Discussionmentioning

confidence: 90%

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Leveraging Patient Reported Outcomes Measurement via the Electronic Health Record to Connect Patients with Cancer to Smoking Cessation Treatment

May

Klass

Davis

et al. 2020

IJERPH

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Tobacco use negatively impacts cancer treatment outcomes, yet too few providers actively support their patients in quitting. Barriers to consistently addressing tobacco use and referring to treatment include time constraints and lack of knowledge surrounding treatment options. Patient Reported Outcomes (PRO) measurement is best practice in cancer care and has potential to help address these barriers to tobacco cessation treatment. This descriptive program evaluation study reports preliminary results following implementation of a novel automated PRO tobacco use screener and referral system via the electronic health record (EHR) patient portal (MyChart) that was developed and implemented as a part of a population-based tobacco treatment program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Between 25 June 2019 and 6 April 2020, 4589 unique patients completed the screener and 164 (3.6%) unique patients screened positive for recent (past month) cigarette smoking. All patients who screened positive were automatically referred to a smoking cessation treatment program integrated within the Lurie Cancer Center, and 71 (49.7%) patients engaged in treatment, as defined by completing at least one behavioral counseling session. Preliminary results indicate that the PRO/MyChart system may improve smoker identification and increase offering of treatment and, despite the “cold call” following a positive screen, may result in a treatment engagement rate that is higher than rates of treatment engagement previously documented in oncology settings. Longer term evaluation with formal statistical testing is needed before drawing conclusions regarding effectiveness, but PRO measurement via the EHR patient portal may serve a potentially important role in a multi-component approach to reaching and engaging cancer patients in comprehensive tobacco cessation treatment.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 90%

Leveraging Patient Reported Outcomes Measurement via the Electronic Health Record to Connect Patients with Cancer to Smoking Cessation Treatment

May

Klass

Davis

et al. 2020

IJERPH

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“…Patient enrollment begins with a positive tobacco use assessment conducted at the first patient visit within the study period, termed the index visit. Initial assessment of patient tobacco use utilizes a standardized Best Practice Alert (BPA) integrated into the EMR and found to be effective in our previous study [18]. This BPA is activated within the check-in and vital sign workflow, requiring assessment of tobacco exposure within the past 30 days, and is satisfied with one of two possible answers (see Fig.…”

Section: Overview Of Study Proceduresmentioning

confidence: 99%

“…All sites use Epic (Epic Systems Corporation, Verona, WI) to deliver care, or an interoperable system. Epic BPA deployment is modifiable, as we have already done within the iLab [18]. Upon opening the Epic Order tab at a patient's next medical visit after the index visit, clinicians will receive the implementation strategy, placed directly over the order interface (Fig.…”

Section: Clinicians Nudgementioning

confidence: 99%

“…The initial intervention resulted in significant improvement in clinician engagement, with referral rates to TUTS rising from baseline 0 to 34% during the 6-month postimplementation period. While the experience suggested that clinician behavior was modifiable, over 60% of default referral orders were declined, implicating additional important barriers to change [18].…”

Section: Introductionmentioning

confidence: 99%

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Rationale and protocol for a cluster randomized pragmatic clinical trial testing behavioral economic implementation strategies to improve tobacco treatment rates for cancer patients who smoke

et al. 2021

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Background Routine evidence-based tobacco use treatment minimizes cancer-specific and all-cause mortality, reduces treatment-related toxicity, and improves quality of life among patients receiving cancer care. Few cancer centers employ mechanisms to systematically refer patients to evidence-based tobacco cessation services. Implementation strategies informed by behavioral economics can increase tobacco use treatment engagement within oncology care. Methods A four-arm cluster-randomized pragmatic trial will be conducted across nine clinical sites within the Implementation Science Center in Cancer Control Implementation Lab to compare the effect of behavioral economic implementation strategies delivered through embedded messages (or “nudges”) promoting patient engagement with the Tobacco Use Treatment Service (TUTS). Nudges are electronic medical record (EMR)-based messages delivered to patients, clinicians, or both, designed to counteract known patient and clinician biases that reduce treatment engagement. We used rapid cycle approaches (RCA) informed by relevant stakeholder experiences to refine and optimize our implementation strategies and methods prior to trial initiation. Data will be obtained via the EMR, clinician survey, and semi-structured interviews with a subset of clinicians and patients. The primary measure of implementation is penetration, defined as the TUTS referral rate. Secondary outcome measures of implementation include patient treatment engagement (defined as the number of patients who receive FDA-approved medication or behavioral counseling), quit attempts, and abstinence rates. The semi-structured interviews, guided by the Consolidated Framework for Implementation Research, will assess contextual factors and patient and clinician experiences with the nudges. Discussion This study will be the first in the oncology setting to compare the effectiveness of nudges to clinicians and patients, both head-to-head and in combination, as implementation strategies to improve TUTS referral and engagement. We expect the study to (1) yield insights into the effectiveness of nudges as an implementation strategy to improve uptake of evidence-based tobacco use treatment within cancer care, and (2) advance our understanding of the multilevel contextual factors that drive response to these strategies. These results will lay the foundation for how patients with cancer who smoke are best engaged in tobacco use treatment and may lead to future research focused on scaling this approach across diverse centers. Trial registration Clinicaltrials.gov, NCT04737031. Registered 3 February 2021.

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Cost-effectiveness of Implementing Smoking Cessation Interventions for Patients With Cancer

et al. 2022

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Key Points Question What is the incremental cost per quit of offering intensive smoking cessation treatment in cancer care clinics relative to standard of care and usual care? Findings In this economic evaluation, the intensive smoking cessation treatment program had an incremental cost per quit of $3906 relative to standard of care and $9866 relative to usual care. Site-specific analyses suggest that the intensive treatment program may achieve incremental costs per quit as low as $2892 and $5408 vs standard and usual care, respectively. Meaning In this study, the incremental cost per quit of an intensive smoking cessation treatment program was comparable with other cessation programs and should be considered as a tobacco treatment model in cancer care.

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Building Systems to Address Tobacco Use in Oncology: Early Benefits and Opportunities From the Cancer Center Cessation Initiative

Cited by 16 publications

References 10 publications

Leveraging Patient Reported Outcomes Measurement via the Electronic Health Record to Connect Patients with Cancer to Smoking Cessation Treatment

Leveraging Patient Reported Outcomes Measurement via the Electronic Health Record to Connect Patients with Cancer to Smoking Cessation Treatment

Rationale and protocol for a cluster randomized pragmatic clinical trial testing behavioral economic implementation strategies to improve tobacco treatment rates for cancer patients who smoke

Cost-effectiveness of Implementing Smoking Cessation Interventions for Patients With Cancer

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