Care-paradigm shift promoting smoking cessation treatment among cancer center patients via a low-burden strategy, Electronic Health Record-Enabled Evidence-Based Smoking Cessation Treatment

Ramsey, Alex T.; Chiu, Ami; Baker, Timothy B.; Smock, Nina; Chen, Jing-Ling; Lester, T J; Jorenby, Douglas E.; Colditz, Graham A.; Bierut, Laura J.; Chen, Li‐Shiun

doi:10.1093/tbm/ibz107

Cited by 32 publications

(70 citation statements)

References 33 publications

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“…The current findings support prior research by demonstrating that the smoking module increases the receipt of evidence-based smoking cessation treatment among cancer patients [26]. These data indicate that smoking cessation treatment engagement was significantly higher in cancer clinics that had implemented the smoking module (31.2%) versus cancer clinics that had not yet implemented the module (17.5%) ( Table 5).…”

Section: Discussionsupporting

confidence: 86%

“…This research was conducted as part of the National Cancer Institute (NCI) Cancer Moonshot program through the Cancer Center Cessation Initiative (C3I) and contributes to a larger effort to build and sustain a smoking cessation program that routinely provides cessation care for cancer patients [26]. This study is a cross-sectional, retrospective quality improvement project which aims to examine smoking prevalence among all patients and smoking cessation treatment engagement among current smokers who visited an outpatient clinic within a large Midwestern healthcare system.…”

Section: Design and Settingmentioning

confidence: 99%

“…We developed the ELEVATE Epic module [26] as a low-burden, point-of-care implementation strategy to systematically facilitate smoking assessment and treatment as part of every in-person clinical encounter. The ongoing purpose of the smoking module is to improve efficiency and efficacy by integrating a variation of the "5 As" framework into an EHR-assisted module.…”

Section: Elevate Epic Modulementioning

confidence: 99%

“…Subsequently, the module facilitates smoking assessment at each following visit, and treatment options are re-offered every 90 days. The components of the ELEVATE Epic module are described fully elsewhere [26].…”

Section: Elevate Epic Modulementioning

confidence: 99%

“…Given the unique challenges and documented treatment gaps in rural clinics, we also explored the effects of a low-burden, point-of-care smoking module that had been implemented in cancer clinics and was potentially scalable to rural settings. Therefore, this study examined the EHR-enabled smoking cessation module (ELEVATE) [26], a system-level implementation strategy designed to improve delivery of evidence-based care, and its effects on treatment access. The present study examines the following questions: (1) whether smoking prevalence differs between rural and urban clinics, (2) whether treatment engagement differs between rural and urban clinics, and (3) whether patients were more likely to receive cessation treatment in cancer clinics that had implemented versus clinics that had not yet implemented the smoking cessation module.…”

Section: Introductionmentioning

confidence: 99%

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Low Burden Strategies Are Needed to Reduce Smoking in Rural Healthcare Settings: A Lesson from Cancer Clinics

Ramsey

Baker

Pham

et al. 2020

IJERPH

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Rural populations face significant smoking-related health disparities, such as a higher prevalence of lung cancer and cancer mortality, higher prevalence of smoking, and lower likelihood of receiving cessation treatment than urban counterparts. A significant proportion of health disparities in rural populations could be eliminated with low-barrier, easy-access treatment delivery methods for smoking cessation. In this study, we assessed treatment engagement among patients in rural and urban settings. Then, we examined the effect of an electronic health record-based smoking cessation module on patient receipt of evidence-based cessation care. As part of a quality improvement project, we retrospectively observed 479,798 unique patients accounting for 1,426,089 outpatient clinical encounters from June 2018–March 2019 across 766 clinics in the greater St. Louis, southern Illinois, and mid-Missouri regions. Smoking prevalence was higher in rural versus urban clinics (20.7% vs. 13.9%, 6.7% [6.3, 7.1], odds ratio = 1.6 [1.6, 1.6], p < 0.0001), and yet rural smokers were nearly three times less likely than their urban counterparts to receive any smoking cessation treatment after adjusting for patients clustering within clinics (9.6% vs. 25.8%, −16.2% [−16.9, −15.5], odds ratio = 0.304 [0.28, 0.33], p < 0.0001). Although not yet scaled up in the rural setting, we examined the effects of a low-burden, point-of-care smoking module currently implemented in cancer clinics. After adjusting for patient clustering within clinics, patients were more likely to receive smoking treatment in clinics that implemented the module versus clinics that did not implement the module (31.2% vs. 17.5%, 13.7% [10.8, 16.6], odds ratio = 2.1 [1.8, 2.6], p < 0.0001). The point-of-care treatment approach offers a promising solution for rural settings, both in and outside the context of cancer care.

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Section: Discussionsupporting

confidence: 86%

Section: Design and Settingmentioning

confidence: 99%

Section: Elevate Epic Modulementioning

confidence: 99%

Section: Elevate Epic Modulementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Low Burden Strategies Are Needed to Reduce Smoking in Rural Healthcare Settings: A Lesson from Cancer Clinics

Ramsey

Baker

Pham

et al. 2020

IJERPH

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Implementing Smoking Cessation Interventions for Tobacco Users Within Oncology Settings

et al. 2023

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ImportancePatients with cancer who continue to smoke tobacco experience greater treatment-related complications, higher risk of secondary cancers, and greater mortality. Despite research to improve smoking cessation care within clinical oncology, implementation of proposed interventions within routine care remains challenging.ObjectiveTo identify and recommend implementation strategies for smoking cessation interventions associated with improved screening, advice-giving, and referral for tobacco users recently diagnosed with cancer, as well as shifting smoking behaviors and attitudes in this patient population.Evidence ReviewMEDLINE, CINAHL, Embase, and PsycINFO databases, as well as Google Scholar, were searched for articles published before September 7, 2020, using terms related to cancer, smoking cessation, and implementation science. Outcomes of interest were study characteristics, implementation strategies, and outcome measures (screening, advice, referral, abstinence rates, and attitudes). The Cochrane Risk of Bias Tool for randomized and nonrandomized studies was used to assess bias. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline and Synthesis Without Meta-analysis (SWiM) guideline. Implementation strategies were categorized according to Expert Recommendations for Implementing Change (ERIC) study taxonomy. A systematic analysis was conducted focusing on studies with low or moderate risk of bias due to high heterogeneity in outcome measurement.FindingsIn total, 6047 records were screened, yielding 43 articles (10 randomized clinical trials and 33 nonrandomized studies). Four strategies were associated with improved screening, advice-giving, and referral: (1) supporting clinicians, (2) training implementation stakeholders (including clinicians), (3) changing the infrastructure, and (4) developing stakeholder interrelationships.Conclusions and RelevanceIn this systematic review, supporting clinicians by providing cessation care through a trained tobacco specialist was identified as important for achieving short-term abstinence and changing attitudes among patients with cancer. Combined with a theoretical framework and stakeholder involvement, these strategies provide the basis for successful implementation of cessation support; this systematic review serves as an illustration of the methodological application and synthesis of implementation studies and other medical conditions more generally.

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Examining disparities in large‐scale patient‐reported data capture using digital tools among cancer patients at clinical intake

Rollison,

Gonzalez,

Turner

et al. 2023

Cancer Medicine

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BackgroundPatient‐reported data can improve quality of healthcare delivery and patient outcomes. Moffitt Cancer Center (“Moffitt”) administers the Electronic Patient Questionnaire (EPQ) to collect data on demographics, including sexual orientation and gender identity (SOGI), medical history, cancer risk factors, and quality of life. Here we investigated differences in EPQ completion by demographic and cancer characteristics.MethodsAn analysis including 146,142 new adult patients at Moffitt in 2009–2020 was conducted using scheduling, EPQ and cancer registry data. EPQ completion was described by calendar year and demographics. Logistic regression was used to estimate associations between demographic/cancer characteristics and EPQ completion. More recently collected information on SOGI were described.ResultsPatient portal usage (81%) and EPQ completion rates (79%) were consistently high since 2014. Among patients in the cancer registry, females were more likely to complete the EPQ than males (odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.14–1.20). Patients ages 18–64 years were more likely to complete the EPQ than patients aged ≥65. Lower EPQ completion rates were observed among Black or African American patients (OR = 0.59, 95% CI = 0.56–0.63) as compared to Whites and among patients whose preferred language was Spanish (OR = 0.40, 95% CI = 0.36–0.44) or another language as compared to English. Furthermore, patients with localized (OR = 1.16, 95% CI = 1.12–1.19) or regional (OR = 1.16, 95% CI = 1.12–1.20) cancer were more likely to complete the EPQ compared to those with metastatic disease. Less than 3% of patients self‐identified as being lesbian, gay, or bisexual and <0.1% self‐identified as transgender, genderqueer, or other.ConclusionsEPQ completion rates differed across demographics highlighting opportunities for targeted process improvement. Healthcare organizations should evaluate data acquisition methods to identify potential disparities in data completeness that can impact quality of clinical care and generalizability of self‐reported data.

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Care-paradigm shift promoting smoking cessation treatment among cancer center patients via a low-burden strategy, Electronic Health Record-Enabled Evidence-Based Smoking Cessation Treatment

Cited by 32 publications

References 33 publications

Low Burden Strategies Are Needed to Reduce Smoking in Rural Healthcare Settings: A Lesson from Cancer Clinics

Low Burden Strategies Are Needed to Reduce Smoking in Rural Healthcare Settings: A Lesson from Cancer Clinics

Implementing Smoking Cessation Interventions for Tobacco Users Within Oncology Settings

Examining disparities in large‐scale patient‐reported data capture using digital tools among cancer patients at clinical intake

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