ASPO Abstracts
Formative Research to Inform Smoking Cessation Initiatives in an urban Cancer Center
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2020
Abstract Body:
Purpose: Smoking increases risk for poor outcomes in most cancers, and diagnosis can increase the salience of cessation for patients who smoke. Although evidence-based approaches to cessation services such as the Five As (Ask, Advise, Assess, Assist, and Arrange) require modest clinician time and effort, many cancer patients do not receive cessation support consistently throughout survivorship. The goal of this formative research was to inform a comprehensive cessation approach within an NCI-designated cancer center in Philadelphia, a city with one of the highest tobacco addiction rates in the U.S.
Methods: We are conducting 25-30 in-depth interviews with purposive samples of cancer care clinicians and other center stakeholders, and with current cancer patients who smoke. Audio-recordings are transcribed verbatim and thematically analyzed, with initial findings informing subsequent sampling and interview content, as well as emerging thematic saturation.
Results: Most patients report at least initial discussions with clinicians about cessation, but not all have been told its direct benefit for survival. Although the majority wish to quit, few have been offered or followed through on referrals to cessation services. Most have attempted reduction strategies, and describe varied preferences for pharmacotherapies, counselling modalities, and interest in exploring complementary strategies during cessation treatment, including mindfulness, exercise, and nutrition. Clinicians report attempting persuasive strategies to address cessation with their patients, but none know evidence-based strategies, such as the 5 As, and most have low self-efficacy regarding the impact of their efforts. All welcome, in principle, a more comprehensive approach to cessation for the cancer center. However, using the 5As at each visit felt too time-consuming, and tracking through the EMR was seen as problematic.
Conclusions: From a predisposing-enabling-reinforcing framework, both patients and clinicians are predisposed to support cessation after cancer diagnosis. However, enabling via clinician training as well as reinforcing infrastructure are needed to change provider behavior during clinical visits, to improve use of evidence-based cessation approaches throughout survivorship.
Keywords: smoking cessation survivorship clinician behavior counseling prevention