A Collaborative Model for Facilitating the Delivery of Smoking Cessation Treatments to Cancer Patients: Results From Three Oncology Practices in South Carolina

Introduction: Continued smoking by cancer patients causes adverse cancer treatment outcomes, but few patients receive evidence-based smoking cessation as a standard of care.Aim: To evaluate practical strategies to promote wide-scale dissemination and implementation of evidence-based tobacco cessation services within state cancer centers.Methods: A Collaborative Learning Model (CLM) for Quality Improvement was evaluated with three community oncology practices to identify barriers and facilitate practice change to deliver evidence-based smoking cessation treatments to cancer patients using standardized assessments and referrals to statewide smoking cessation resources. Patients were enrolled and tracked through an automated data system and received follow-up cessation support post-enrollment. Monthly quantitative reports and qualitative data gathered through interviews and collaborative learning sessions were used to evaluate meaningful quality improvement changes in each cancer center.Results: Baseline practice evaluation for the CLM identified the lack of tobacco use documentation, awareness of cessation guidelines, and awareness of services for patients as common barriers. Implementation of a structured assessment and referral process demonstrated that of 1,632 newly registered cancer patients,1,581 (97%) were screened for tobacco use. Among those screened, 283 (18%) were found to be tobacco users. Of identified tobacco users, 207 (73%) were advised to quit. Referral of new patients who reported using tobacco to an evidence-based cessation program increased from 0% at baseline across all three cancer centers to 64% (range = 30%–89%) during the project period.Conclusions: Implementation of quality improvement learning collaborative models can dramatically improve delivery of guideline-based tobacco cessation treatments to cancer patients.

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Implementation Science to Improve Tobacco Cessation Services in Oncology Care

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2021.7094 ◽

2021 ◽

Vol 19 (Suppl_1) ◽

pp. S12-S15

Author(s):

_ _

Keyword(s):

Implementation Science ◽

Tobacco Use ◽

Working Group ◽

Tobacco Cessation ◽

Common Interest ◽

Evidence Based ◽

Cancer Centers ◽

Tobacco Treatment ◽

Oncology Care ◽

Science Working

Every patient with cancer deserves access to evidence-based tobacco cessation interventions as part of their routine oncology care. The NCI Cancer Moonshot funded the Cancer Center Cessation Initiative (C3I) to help establish and/or expand tobacco treatment programs at 52 NCI-designated Cancer Centers. Although this initiative has broadened the availability of tobacco treatment services across US cancer centers, the reach and utilization of these services remains low among patients. To help address the remaining gap between the availability and utilization of evidence-based treatments for tobacco use in the oncologic context, staff and investigators at C3I sites and the C3I Coordinating Center formed the C3I Implementation Science Working Group. The mission of this working group is to bring together clinicians, scientists, and policymakers who share a common interest in implementation science and treating tobacco use in the oncologic context to collaborate on projects aimed at shrinking the practice gap in this area. Through case study examples, we describe how the C3I Implementation Science Working Group is supporting efforts to identify effective ways to increase the utilization of evidence-based tobacco treatments within cancer treatment settings and promote the broader impact and long-term sustainability of C3I.

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Supporting cancer patients quit smoking: the initial evaluation of our tobacco cessation intervention program

Journal of Radiotherapy in Practice ◽

10.1017/s1460396919000451 ◽

2019 ◽

Vol 19 (2) ◽

pp. 163-172 ◽

Cited By ~ 1

Author(s):

Ernest Osei ◽

Rahil Kassim ◽

Kelly A. Cronin ◽

Barbara-Anne Maier

Keyword(s):

Smoking Cessation ◽

Cancer Patients ◽

Tobacco Use ◽

Initial Evaluation ◽

Smoking Cessation Program ◽

Sufficient Evidence ◽

Evidence Based ◽

Quit Smoking ◽

Cessation Intervention ◽

Readiness To Quit

AbstractBackground:Tobacco is a known addictive consumer product and its use has been reported to be associated with several health problems as well as the leading cause of premature, preventable mortality worldwide. For patients undergoing cancer treatment, tobacco smoking can potentially compromise treatment effectiveness; however, there is sufficient evidence suggesting numerous health benefits of smoking cessation interventions for cancer patients.Methods:The Grand River Regional Cancer Centre (GRRCC) smoking cessation program began in October 2013 to provide evidence-based intensive tobacco intervention to patients. All new patients are screened for tobacco use and those identified as active smokers are advised of the benefits of cessation and offered referral to the program where a cessation nurse offers counseling. Patients’ disease site, initial cessation goal, quit date, number of quit attempts and mode of contact are collected by the cessation nurse. This study reports on the initial evaluation of the smoking cessation program activities at GRRCC.Results:There are 1,210 patients who were screened, accepted a referral and counseled in the program. The referral pattern shows a modest increase every year and most of the patients (58%) indicated readiness to quit smoking. Overall, 29 and 26% of patients either quit or cut-back smoking, respectively. Among 348 patients who quit smoking, 300 (86%) were able to quit at the first attempt. The data indicated that 309 (44%) out of the 698 patients who indicated their initial intent to quit smoking were able to quit, whereas about 242 (35%) were able to cutback. A total of 15 patients out of 32 who indicated initial readiness to ‘cutback’ smoking were able to reduce tobacco use and three patients actually ended up quitting, although their initial goal was ‘ready-to-cut-back’.Conclusions:GRRCC smoking cessation program started in October 2013 to provide evidence-based intensive smoking cessation interventions for patients with cancer. Most patients referred to the program indicated a readiness to quit smoking affirming that if patients become aware of the various risks associated with continual smoking or if they are informed of the benefits associated with cessation with regard to their treatment, they will be more likely to decide to quit. Therefore, it is essential that patients, their partners and families are counseled on the health and treatment benefits of smoking cessation and sustainable programs should be available to support them to quit smoking. It is imperative then, that oncology programs should consistently identify and document the smoking status of cancer patients and support those who use tobacco at the time of diagnosis to quit. Evidence-based smoking cessation intervention should be sustainably integrated into the cancer care continuum in all oncology programs from prevention of cancer through diagnosis, treatment, survivorship and palliative care.

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Canada's Progress to Make Smoking Cessation a First-Line Cancer Treatment

Journal of Global Oncology ◽

10.1200/jgo.18.15400 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 90s-90s

Author(s):

M. Halligan ◽

D. Keen

Keyword(s):

Smoking Cessation ◽

Cancer Treatment ◽

Cancer Patients ◽

Smoking Status ◽

Scale Up ◽

Evidence Based ◽

First Line ◽

Quit Smoking ◽

Substantial Progress ◽

Oncology Practice

Background: Evidence indicates that smoking cessation improves the effectiveness of treatment and likelihood of survival among all cancer patients, not just those with tobacco-related disease, yet smoking is rarely addressed in oncology practice. Prior to 2016, only 3 provinces in Canada (out of a total of 10 provinces and three territories) reported implementation of smoking cessation for ambulatory cancer patients. Aim: Based on this evidence, the Canadian Partnership Against Cancer (CPAC) implemented a systems change initiative to promote adoption of evidence-based smoking cessation within provincial and territorial cancer systems across Canada. Methods: In 2016, CPAC funded seven provinces and two territories over a 15-month period to plan, implement or evaluate integration of evidence-based smoking cessation for ambulatory cancer patients within cancer systems. Funds were used to plan (2 provinces and 2 territories), implement (3 provinces) or evaluate (2 provinces) systematic, evidence-based approaches to smoking cessation within ambulatory cancer care settings (e.g., establishing routine systems for identification of smoking cancer patients and system to support patients to quit). Funds could not be used for direct service delivery (e.g., cessation counseling). Results: After 15-months of funding from CPAC, 6 provinces reported implementation of smoking cessation for ambulatory cancer patients. The remaining province and 2 territories funded by CPAC reported development of plans for adoption of smoking cessation for cancer patients in the future. Within provinces reporting implementation of smoking cessation for cancer patients, between 65%-97% of ambulatory cancer patients were screened for smoking status; 22%-80% of these patients were offered a referral to cessation services, and 21%-45% of cancer patients accepted a referral. Conclusion: Despite provincial and territorial variations in readiness to uptake evidence-based smoking cessation for cancer patients, CPAC's approach has led to substantial progress in adoption of this approach across Canada. While progress has been made, adoption of smoking cessation and relapse prevention by cancer systems is not yet widespread in Canada. Scale-up to remaining provinces and territory, and spread within existing provinces and territories is required to reach all cancer patients and families who require support to quit smoking. Framing smoking cessation as a therapeutic intervention, not prevention, and a routine part of cancer treatment will be critical for sustainability of this work.

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Evidence for the Fidelity and Effectiveness of Living Independent From Tobacco for People with Disabilities and Their Caregivers

Tobacco Use Insights ◽

10.1177/1179173x18825075 ◽

2019 ◽

Vol 12 ◽

pp. 1179173X1882507 ◽

Cited By ~ 2

Author(s):

Susan M Havercamp ◽

Wesley R Barnhart ◽

David Ellsworth ◽

Erica Coleman ◽

Allison Lorenz ◽

...

Keyword(s):

Social Support ◽

Health Promotion ◽

Tobacco Use ◽

Tobacco Cessation ◽

People With Disabilities ◽

Evidence Based ◽

The People ◽

Post Test ◽

Health Related ◽

Health Promotion Interventions

People with disabilities (PWD) are more likely to use tobacco and less likely to access tobacco cessation programs compared with people without disabilities. Living Independent From Tobacco (LIFT), an evidence-based intervention designed for PWD, was piloted with dyads of PWD (n = 5) and their caregivers (n = 7). As an important source of practical and social support for PWD, caregivers also impact health-related attitudes, knowledge, and behaviors of PWD. Caregivers who smoke may unwittingly interfere with cessation efforts of the people they support. We found that LIFT could be offered to dyads of PWD and their caregivers with fidelity. The intervention was associated with increased use of coping strategies and self-efficacy to reduce smoking. Tobacco use decreased at post-test (−34.94%), with further reduction 6-months after the intervention (−50.60%). Implications for offering inclusive health promotion interventions to both PWD and their caregivers are discussed.

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Using a statewide collaborative approach to improve tobacco cessation referral rates for cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.74 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 74-74

Author(s):

Jane Alcyne Severson ◽

Hilary Baca ◽

Douglas W. Blayney ◽

Karen Brown ◽

Grayce Galiyas ◽

...

Keyword(s):

Cancer Patients ◽

Tobacco Use ◽

Tobacco Cessation ◽

Scientific Evidence ◽

Demonstration Project ◽

Second Primary ◽

Root Cause ◽

Use Of Data ◽

Lean Tools ◽

Oncology Practice

74 Background: Tobacco use by cancer patients decreases the effectiveness of cancer treatment, increases treatment toxicity, increases the risk of developing a second primary cancer, and increases mortality. Stopping tobacco use may reduce many of these adverse effects in cancer patients. Methods: The Michigan Oncology Quality Consortium (MOQC) collaborated with the Michigan Cancer Consortium (MCC) to implement the Tobacco Cessation Demonstration Project. This entailed designing a standard workflow and other lean tools to assist oncology practices in referring all cancer patients who use tobacco to the free Michigan Tobacco QuitLine or other cessation services. 19 practices participated in three learning sessions during which the following were provided: education by subject matter experts, use of data management and lean tools, and the sharing of barriers and successes. Results: Examination of baseline MOQC Quality Oncology Practice Initiative (QOPI) data demonstrated that < 47% of patients who use tobacco were advised to quit or referred for tobacco cessation (n = 574 charts/44 sites), which was equivalent to the national QOPI mean in Fall 2012. Root cause analysis of this lack of action in tobacco cessation identified limited knowledge to the risks of continued smoking and the lack of available resources as barriers to adopting necessary change. Implementation of the MOQC/MCC Tobacco Cessation Demonstration Project increased total statewide referrals to the QuitLine by 30.9% over the first 2 months with an increasing proportion of patients (41%) being cancer patients referred by MOQC participating sites. Conclusions: Supplying scientific evidence, collaboration, and the use of lean tools improved the referral rate to a tobacco cessation program for oncology patients. [Table: see text]

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Seeing the quality improvement forest through the quality improvement trees: A meta-synthesis of case studies in Florida and Georgia

SAGE Open Medicine ◽

10.1177/2050312119845703 ◽

2019 ◽

Vol 7 ◽

pp. 205031211984570 ◽

Cited By ~ 1

Author(s):

William C Livingood ◽

Lori Bilello ◽

Katryne Lukens-Bull

Keyword(s):

Public Health ◽

Quality Improvement ◽

Case Studies ◽

Group Dynamics ◽

Critical Role ◽

Lessons Learned ◽

Quality Improvement Intervention ◽

Dissemination And Implementation ◽

Evidence Based ◽

Healthcare Settings

Objectives: To identify important characteristics of quality improvement applications for population health and healthcare settings and to explore the use of quality improvement as a model for implementing and disseminating evidence-based or best practices. Methods: A meta-synthesis was used to examine published quality improvement case studies. A total of 10 published studies that were conducted in Florida and Georgia were examined and synthesized using meta-synthesis (a qualitative research methodology) for meaningful insights and lessons learned using defined meta-synthesis inclusion criteria. The primary focus of the analysis and synthesis were the reported processes and findings that included responses to structured questioning in addition to emergent results from direct observation and semi-structured open-ended interviewing. Results: The key insights for the use of quality improvement in public health and healthcare settings included (1) the essential importance of data monitoring, analysis, and data-based decision making; (2) the need to focus on internal mutable factors within organizations; (3) the critical role of quality improvement team group dynamics; (4) the value of using a quality improvement collaborative or multi-clinic quality council/committee for sharing and comparing performance on key metrics; and (5) the need to identify a quality improvement approach and methods for clarification as a structured quality improvement intervention. Conclusion: In addition to the advantages of using quality improvement to enhance or improve healthcare and public health services, there is also potential for quality improvement to serve as a model for enhancing the adoption of evidence-based practices within the context of dissemination and implementation research.

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Evaluation of a dedicated institutional tobacco cessation service for thoracic clinic cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1603 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1603-1603

Author(s):

Katharine Ann Dobson Amato ◽

Michael Zevon ◽

Pat Hysert ◽

Robert Hysert ◽

Stephanie Segal ◽

...

Keyword(s):

Cancer Patients ◽

Tobacco Use ◽

Tobacco Cessation ◽

Participation Rate ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Therapeutic Outcomes ◽

High Risk Cancer ◽

First Contact

1603 Background: Tobacco use by cancer patients is associated with poor therapeutic outcomes including increased toxicity, decreased quality of life, and decreased survival. Though recommendations provide for tobacco assessment and cessation for cancer patients, few oncologists provide cessation support. Presented are data from universal tobacco assessment and cessation program for patients presenting at a thoracic oncology clinic in a NCI Designated Comprehensive Cancer Center. Methods: A standard set of evidence based tobacco assessment questions were incorporated into an automated electronic medical record based system delivered by nursing at initial consult and at follow-up. Patients eligible for tobacco cessation support (i.e. patients self-reporting tobacco use within 30 days) were automatically referred to a dedicated tobacco cessation service. All referred patients are sent a standardized packet of cessation materials with telephone-based follow-up by trained cessation counselors. Results: A total of 980 new thoracic clinic patients were referred to the cessation service from January 2011 and October 2012. Two-thirds of the patients referred (n=728) referred into the system were current smokers and the remainder had quit in the 30 days prior to assessment. Among the 788 patients with contact attempts by the cessation service, 81.2% (n=640) were successfully contacted and only 2.5% (n=20) refused the offer of cessation support. At first contact, 75.6% (n=484) of patients reported continued current tobacco use. Follow-up calls were placed for 53.1% (n=340) of those who participated in the first contact an average of 39 days after the first successful contact. The follow-up had a 93.2% (n=317) participation rate which revealed that 33.3% (n=106) reported not smoking, an 8.9% increase since the first cessation service telephone call. Conclusions: Data demonstrate that an automated tobacco assessment and cessation service for thoracic oncology patients can effectively generate a large mandatory referral base with high patient interest in cessation, and that cessation support can be implemented and maintained in high risk cancer patients.

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CEASE: A novel patient directed electronic smoking cessation platform for cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.6584 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 6584-6584

Author(s):

Jennifer M. Jones ◽

Geoffrey Liu ◽

Peter Selby ◽

Lawson Eng ◽

David Paul Goldstein ◽

...

Keyword(s):

Time Series ◽

Smoking Cessation ◽

Cancer Patients ◽

Tobacco Use ◽

Self Report ◽

Process Of Care ◽

Referral Rates ◽

Increased Risk ◽

Patient Reported ◽

The Impact

6584 Background: Continued smoking in cancer patients receiving treatment results in decreased efficacy, reduced survival, amd increased risk of recurrence. Despite ASCO and AACR policy statements, routine tobacco use screening and provision of smoking cessation treatment has not been widely implemented in the cancer setting. A paper-based tobacco use screening and clinician-dependent referral program for new ambulatory cancer patients was initiated at Princess Margaret Cancer Centre in 2013 resulting in moderate screen rates but low referral rates. In response, we developed and implemented a tailored patient directed electronic smoking cessation platform (CEASE) which included three elements:1) tobacco use assessment tool; 2) patient education on benefits of cessation; 3) a patient directed automatic referral system to smoking cessation programs. Methods: Interrupted time series design to examine the impact of CEASE on process of care (screening rates, referrals offered and accepted) and patient reported (quit attempts, smoking status, uptake of cessation programs) outcomes. Included 20 monthly intervals: 6 pre implementation (Apr-Sept 2015) (PRE), 8 gradual implementation across all tumour sites (Oct 2015-May 2016), and 6 postb implementation (Jun 2016-Nov 2016) (POST). A time series segmented linear regression was conducted to evaluate changes in process of care outcomes (excluding the implementation period). Pre-post self-report patient outcome data was also compared. Results: We assessed data from n = 3785 (PRE) and n = 4726 (POST) new patients. Screening rates increased from 44% using the paper-based approach to 65% with CEASE (p = 0.0019). Referrals offered to smokers who were willing to quit increased from 24% to 100% (p < 0.0001). Accepted referrals decreased from 45% to 26%; though the overall referral rate increased from 11% to 26% (p = 0.0001). The proportion of those using tobacco or attempting to quit did not differ at 3-months. However, engagement with the referral source increased from 4% to 62.5% (p < 0.001). Conclusions: CEASE was successfully implemented across all clinics and resulted in improvements in overall screening and referral rates and engagement with referral services.

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Uptake and efficacy of using a state quitline to address tobacco use by cancer patients treated in community cancer centers.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.e18530 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. e18530-e18530 ◽

Cited By ~ 1

Author(s):

Anna E Schulze ◽

Karen Brown ◽

Polly Hager ◽

Laura Petersen ◽

Hilary Baca ◽

...

Keyword(s):

Cancer Patients ◽

Tobacco Use ◽

Cancer Centers

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Integration of an evidence-based tobacco cessation program into a substance use disorders program to enhance equity of treatment access for northern, rural, and remote communities

Translational Behavioral Medicine ◽

10.1093/tbm/ibz162 ◽

2020 ◽

Vol 10 (3) ◽

pp. 555-564

Author(s):

Patricia M Smith ◽

Lisa D Seamark ◽

Katie Beck

Keyword(s):

Substance Use ◽

Behavior Change ◽

Tobacco Use ◽

Tobacco Cessation ◽

Access Point ◽

Indigenous Communities ◽

Well Being ◽

Evidence Based ◽

Treatment Access ◽

Cessation Intervention

Abstract Integrating tobacco cessation interventions into substance use disorder (SUD) programs is recommended, yet few are implemented into practice. This translational research implementation study was designed to integrate an evidence-based tobacco cessation intervention into a 2-week hospital outpatient SUD program that served a rural municipality and 33 remote Indigenous communities. Objectives included determining tobacco use prevalence, intervention uptake, and staffing resources required for intervention delivery. A series of 1-hr tobacco and health/well-being interactive education and behavior-change groups were developed for the SUD program to create a central access point to offer an evidence-based, intensive tobacco cessation intervention that included an initial counseling/planning session and nine post-SUD treatment follow-ups (weekly month 1; biweekly month 2; and 3, 6, and 12 months). Group sign-in data included age, gender, community, tobacco use, and interest in receiving tobacco cessation help. Thirty-two groups (April 2018 to February 2019) were attended by 105 people from 22 communities—56% were female, mean age = 30.9 (±7.3; 93% <45 years), 86% smoked, and 38% enrolled in the intensive tobacco cessation intervention. The age-standardized tobacco use ratio was two times higher than would be expected in the general rural population in the region. Average staff time to provide the intervention was 1.5–2.5 hr/week. Results showed that a Healthy Living group integrated into SUD programming provided a forum for tobacco education, behavior-change skills development, and access to an intensive tobacco cessation intervention for which enrollment was high yet the intervention could be delivered with only a few staff hours a week.

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