Implementation of a Novel Electronic Patient-Directed Smoking Cessation Platform for Cancer Patients: Interrupted Time Series Analysis.

Meredith Elana Giuliani,Nazek Abdelmutti,Jennifer Michelle Jones,Geoffrey Liu,Wei Xu,David Paul Goldstein,Lawson Eng,Peter Selby,Dongyang Yang,Mihaela Dirlea,Janet Papadakos

doi:10.2196/11735

Abstract

BackgroundContinued smoking in cancer patients undergoing treatment results in significantly higher rates of treatment toxicities and persistent effects, increased risk of recurrence and second malignancy, and increased all-cause mortality. Despite this, routine tobacco use screening and the provision of smoking cessation treatment has yet to be implemented widely in the cancer setting.ObjectiveThe objective of this study was to implement and evaluate the adoption and impact of an innovative Smoking Cessation e-referral System (CEASE) to promote referrals to smoking cessation programs in cancer patients.MethodsA patient-directed electronic smoking cessation platform (CEASE) was developed to promote smoking screening and referral and implemented at 1 of Canada’s largest cancer centers. The implementation and evaluation were guided by the Ottawa Model of Research Use. An interrupted time series design was used to examine the impact of CEASE on screening rates, referrals offered, and referrals accepted compared with a previous paper-based screening program. A subsample of smokers or recent quitters was also assessed and compared pre- and postimplementation to examine the effect of CEASE on subsequent contact with smoking cessation programs and quit attempts.ResultsA total of 17,842 new patients attended clinics over the 20-month study period. The CEASE platform was successfully implemented across all disease sites. Screening rates increased from 44.28% (2366/5343) using the paper-based approach to 65.72% (3538/5383) using CEASE (P<.01), and referrals offered to smokers who indicated interest in quitting increased from 18.6% (58/311) to 98.8% (421/426; P<.01). Accepted referrals decreased from 41% (24/58) to 20.4% (86/421), though the overall proportion of referrals generated from total current/recent tobacco users willing to quit increased from 5.8% (24/414) to 20.2% (86/426) due to the increase in referrals offered. At 1-month postscreening, there was no significant difference in the proportion that was currently using tobacco and had not changed use in the past 4 weeks (pre: 28.9% [24/83] and post: 28.8% [83/288]). However, contact with the referral program increased from 0% to 78% in the postCEASE cohort (P<.001).ConclusionsCEASE is an innovative tool to improve smoking screening and can be implemented in both a time- and cost-effective manner which promotes sustainability. CEASE was successfully implemented across all clinics and resulted in improvements in overall screening and referral rates and engagement with referral services.

Highlights

BackgroundIt is widely recognized that smoking cessation will decrease the risk of developing certain cancers [1]
Cancer Care Ontario (CCO), an agency which oversees the quality of cancer services in the province of Ontario, conducted an environmental scan to determine the need for a standardized approach of smoking cessation programs within the cancer system and subsequently developed a Smoking Cessation Advisory Committee, which established a plan and provided guidance for the implementation of a smoking cessation program in regional cancer centers within Ontario
In an effort to align with CCO recommendations, a paper-based screening program was implemented throughout Princess Margaret Cancer Centre (PM) between 2014 and 2016 with the goal that every new patient at PM be screened for smoking status and provided with a smoking cessation referral or resource when appropriate

Summary

Introduction

BackgroundIt is widely recognized that smoking cessation will decrease the risk of developing certain cancers [1]. There is a large body of evidence which demonstrates that continued smoking after a cancer diagnosis leads to significantly higher rates of treatment toxicities and persistent effects [1,2,3,4,5,6,7], increased the risk of recurrence and second malignancy [1,3,4,8,9,10,11], and increased all-cause mortality [1,2,3,8,9,10,12,13,14]. Continued smoking in cancer patients undergoing treatment results in significantly higher rates of treatment toxicities and persistent effects, increased risk of recurrence and second malignancy, and increased all-cause mortality. Routine tobacco use screening and the provision of smoking cessation treatment has yet to be implemented widely in the cancer setting

Methods

Results

Discussion

Conclusion