Integrating Tobacco Use Assessment and Treatment in the Oncology Setting: Quality Improvement Results from the Georgetown Lombardi Smoking Treatment and Recovery Program

Abstract

As part of the NCI’s Cancer Center Cessation (C3i) initiative, we initiated, expanded, and maintained an evidence-based tobacco treatment program at the Georgetown Lombardi Comprehensive Cancer Center. We present a quality improvement (QI) assessment of the implementation process and patient-level outcomes. At two hematology/oncology outpatient clinical sites, five oncology-based teams (clinical administrators, clinical staff, pharmacy, information technology, and tobacco treatment staff) developed implementation strategies for opt-out patient assessment and enrollment, centralized tobacco treatment, audit, feedback, and staff training. Among eligible patients (tobacco use in ≤30 days), we assessed demographic, clinical, and tobacco-related characteristics to examine predictors of enrollment (baseline completed), treatment engagement (≥one sessions completed), and self-reported 7-day abstinence (6 months post-enrollment). Across both sites, medical assistants screened 19,344 (82.4%) patients for tobacco use, which identified 1345 (7.0%) current tobacco users, in addition to 213 clinician referrals. Of the 687/1256 (54.7%) eligible patients reached, 301 (43.8%) enrolled, and 199 (29.0%) engaged in treatment, of whom 74.5% were African American and 68% were female. At the larger site, significant multivariate predictors of enrollment included African American race (vs. white/other) and clinician referral (vs. MA assessment). Treatment engagement was predicted by greater nicotine dependence, and abstinence (27.4%) was predicted by greater treatment engagement. In summary, the systematic utilization of multiple oncology-based teams and implementation strategies resulted in the development and maintenance of a high-quality, population-based approach to tobacco treatment. Importantly, these strategies addressed inequities in tobacco treatment, as the program reached and engaged a majority-African-American patient population. Finally, the opt-out patient assessment strategy has been implemented in multiple oncology settings at MedStar Health through the Commission on Cancer’s Just Ask program.

Implementation, enrollment, and engagement in an opt‐out telehealth pharmacist‐assisted tobacco treatment program for patients seen in oncology outpatient clinics

“…35 The findings from this study contribute to the increasing evidence demonstrating the feasibility of using electronic health records and opt-out strategies to identify and proactively deliver smoking cessation treatments to patients in health care settings. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Overall, opt-out smoking cessation treatment was delivered to 45.5% of currently smoking patients referred to the TTP. Importantly, among 1967 patients reached and eligible for TTP enrollment, only 23.3% (458 of 1967) affirmatively refused enrollment.…”

“…13,14 The published literature includes many informative examples of how electronic health records can be used to identify patients who smoke and support smoking cessation interventions for patients with cancer and other types of patients seen in health care settings. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] As a result of this literature and feedback received from our patients, the HCC instituted an opt-out telehealth pharmacyassisted tobacco treatment program (TTP) as our primary mode for offering patients smoking cessation support. The TTP includes 4 components: (1) screening of electronic health records to identify patients who currently smoke and who were seen across 43 HCC outpatient oncology clinics; (2) opt-out referral of patients to the TTP for those who have not previously been offered the TTP in the past 6 months; (3) telephone outreach to patients to offer them the opportunity to enroll in the TTP which consists of up to 4 counseling calls and free smoking cessation nicotine replacement therapy medications mailed to their home for those deemed eligible for pharmacotherapy; and (4) follow-up evaluation which involves recontacting a random sample of referred patients 4 to 12 months after referral to the TTP to independently assess smoking status and collect feedback useful for ongoing quality improvement.…”