Nurse-facilitated tobacco treatment in cancer patients who smoke

Authors: Katz DA, Mott SL, Utech J, Podaril D, Bahlmann A, Laux D, Furqan M, Pollock Z, Vander Weg MW

Category: Lifestyles Behavior, Energy Balance & Chemoprevention
Conference Year: 2020

Abstract Body:
Purpose: To determine the effectiveness of a clinic-wide intervention on the delivery of tobacco cessation counseling and use of pharmacotherapy in patients with cancer. Methods: We conducted a pragmatic implementation trial with a before-after design in 119 current or recently quit smokers who received care at a single NCI-designated comprehensive cancer center (n=61 pre-intervention, n=58 post-intervention). Adult patients (pts) with a confirmed diagnosis of cancer who smoked > 1 cigarette per day (or who quit smoking within the past 30 days) and had a scheduled appointment with an oncologist (index visit) were eligible, regardless of their readiness to quit. Building on the Chronic Care Model, we used the following strategies to implement the National Comprehensive Care Network (NCCN) guidelines for smoking cessation: 1) Training nursing staff to provide brief cessation counseling (Ask-Advise-Refer approach), 2) creating a best practice advisory to facilitate referral to an on-site certified tobacco treatment specialist (TTS), 3) delivering intensive tobacco cessation counseling (with up to 6 follow-up calls), 4) setting up quick orders for prescribing tobacco cessation pharmacotherapy, and 5) practice facilitation by a nurse champion. We conducted exit interviews to assess delivery of smoking cessation counseling (5 A’s, ask-advise-assess- assist-arrange follow-up) during the index visit and interviewed pts by phone to assess use of pharmacotherapy to quit smoking and whether they had discussed smoking cessation with a healthcare professional during 3-mo follow-up. Performance of the 5 A’s was compared across the pre- and post- intervention periods using logistic regression, accounting for clustering by nursing staff. Results: More patients had received any assistance in quitting during the intervention period compared to the pre-intervention period (30 vs. 10%, p<.01). At 3-month follow-up, 56 and 32% of participants had discussed smoking cessation with a healthcare professional (p=.02), and 59 and 27% of participants had used pharmacotherapy (p<.01), respectively. Conclusions: A multi- component tobacco treatment intervention increased the proportion of smokers who received elements of guideline-recommended tobacco treatment during usual cancer care.

Keywords: smoking cessation, counseling, drug therapy, practice guideline, cancer care facilities