Implementation of a Comprehensive Smoking Cessation Program in Cancer Care

Abdelmutti, Nazek; Brual, Janette; Papadakos, Janet; Fathima, Sameera; Goldstein, David P.; Eng, Lawson; Papadakos, Tina; Liu, G.; Jones, Jennifer; Giuliani, Meredith

doi:10.3747/co.26.5201

Cited by 17 publications

(36 citation statements)

References 28 publications

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“…In addition, the initiative utilized a workflow that provided feedback and consultation with the patient's medical team to enhance coordination of patient-centered care and to close the treatment loop. This QI initiative observed a level of patient tobacco treatment engagement higher than other comprehensive tobacco treatment services within oncology settings [30,31], which tend to be about 20%. With regard to abstinence outcomes, the University of Texas MD Anderson Cancer Center, which provides a comprehensive approach to tobacco treatment, has reported a 9-month abstinence rate of 38% among 2779 individuals treated from 2006-2013.…”

Section: Discussionmentioning

confidence: 84%

Integration of Tobacco Treatment Services into Cancer Care at Stanford

Gali

Pike

Kendra

et al. 2020

IJERPH

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As part of a National Cancer Institute Moonshot P30 Supplement, the Stanford Cancer Center piloted and integrated tobacco treatment into cancer care. This quality improvement (QI) project reports on the process from initial pilot to adoption within 14 clinics. The Head and Neck Oncology Clinic was engaged first in January 2019 as a pilot site given staff receptivity, elevated smoking prevalence, and a high tobacco screening rate (95%) yet low levels of tobacco cessation treatment referrals (<10%) and patient engagement (<1% of smokers treated). To improve referrals and engagement, system changes included an automated “opt-out” referral process and provision of tobacco cessation treatment as a covered benefit with flexible delivery options that included phone and telemedicine. Screening rates increased to 99%, referrals to 100%, 74% of patients were reached by counselors, and 33% of those reached engaged in treatment. Patient-reported abstinence from all tobacco products at 6-month follow-up is 20%. In July 2019, two additional oncology clinics were added. In December 2019, less than one year from initiating the QI pilot, with demonstrated feasibility, acceptability, and efficacy, the tobacco treatment services were integrated into 14 clinics at Stanford Cancer Center.

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Section: Discussionmentioning

confidence: 84%

Integration of Tobacco Treatment Services into Cancer Care at Stanford

Gali

Pike

Kendra

et al. 2020

IJERPH

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“…Notably, neither of these studies comment on the magnitude of change in referral uptake following OH-CCO’s newly adapted smoking cessation framework. Published data most comparable to our own were from one RCP’s implementation of a digitally based smoking cessation program utilizing the 3As Framework and an electronic referral system, with modest success in referral uptake of 20% between April 2016 and March 2018 [ 14 ]. However, the screening rate using an electronic intervention system was lower than data reported in this study (62% and 90.1%, respectively), as was the referral uptake (20% and 34.7%, respectively).…”

Section: Discussionmentioning

confidence: 92%

“…One of the greatest challenges when referring patients to tobacco cessation services are the limitations to accessing these supports. In Ontario, only 31% of hospitals report allocating resources to smoking cessation activities, and of these, only 42% designate staff to provide cessation support using these funds [ 14 ]. While the majority of Ontario hospitals provide no-cost nicotine replacement therapy (NRT), self-help materials, and community referrals, these processes are primarily in place for inpatient departments, and not routinely offered in the outpatient setting [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Implementing a 3As and ‘Opt-Out’ Tobacco Cessation Framework in an Outpatient Oncology Setting

2021

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Tobacco cessation has been recognized as an important goal for all ambulatory cancer centres to provide the best possible treatment outcomes and quality of life. However, cessation interventions are applied inconsistently in this setting, with less than one-half of tobacco users being offered evidence-based interventions. The ‘opt-in’ approach traditionally used in cessation, which targets patients who feel ready to quit, may limit the number of patients who are able to receive treatment, and evidence suggests that tobacco users quit at the same rate regardless of their perceived readiness. This paper reports the results of implementing a tobacco cessation framework utilizing the 3As and an ‘opt-out’ approach as a standard of cancer care at a Regional Cancer Centre. A comparison of data from 2017–2018 and 2018–2019 demonstrated an increase in the number of patients screened for tobacco use (76.9% to 90.1%, respectively), and in the number of accepted referrals to quit support (11.5% to 34.7%, respectively). The revised framework was effective at improving referral acceptance rates, despite tobacco use rates remaining stable among the two groups. This demonstrates that employing the ‘opt-out’ approach is a more effective strategy to connect patients with the smoking cessation supports required to optimize their cancer care.

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“…It is reassuring that our initial results indicate that the PRO system approach may produce high engagement rates, though lower than those observed for provider referrals (49% versus 68%, respectively). Both approaches appear to produce higher than the average engagement in treatment, which has been found to be about 20% in oncology settings [47,48]. Optimizing reach and engagement will likely require a multicomponent approach comprised of automated PRO tobacco screening and referral via the patient portal prior to oncology visits, provider referral of patients seen in the oncology clinic, and a tobacco use registry to identify and proactively reach smokers who are not receiving cancer treatment.…”

Section: Discussionmentioning

confidence: 99%

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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Implementation of a Comprehensive Smoking Cessation Program in Cancer Care

Cited by 17 publications

References 28 publications

Integration of Tobacco Treatment Services into Cancer Care at Stanford

Integration of Tobacco Treatment Services into Cancer Care at Stanford

Implementing a 3As and ‘Opt-Out’ Tobacco Cessation Framework in an Outpatient Oncology Setting

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

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