ASPO Abstracts
Multilevel determinants of tobacco dependence treatment program implementation in NCI-Designated cancer centers in the Cancer Center Cessation Initiative
Category: Lifestyles Behavior, Energy Balance & Chemoprevention
Conference Year: 2022
Abstract Body:
Purpose: Providing tobacco dependence treatment to cancer patients who smoke improves tobacco and cancer outcomes, but treatment is not consistently offered. Here, we examine determinants of tobacco dependence treatment implementation across NCI-Designated cancer centers in the Cancer Center Cessation Initiative (C3I). Methods: We conducted a mixed-methods study of survey data and semi-structured interviews conducted among Program Leads from 20 C3I-funded cancer centers. We calculated descriptive statistics of survey data and applied directed content analysis to interview transcripts. We organized coded data into constructs representing the Consolidated Framework for Implementation Research. We then grouped centers based on survey data of intervention, inner, and outer setting characteristics (e.g., treatment components offered, length of time since program initiation, patient smoking rate) to identify determinants of implementation. Results: The most offered tobacco treatment interventions were in-person (85% of centers) and telephone (70%) counseling and pharmacotherapy (80%). Over half (53%) had been implementing their program for over two years. Smoking prevalence rates across centers ranged from 4% to 47%. Most cited barriers to implementation included inner setting challenges related to leadership and provider buy-in, program compatibility with workflows and IT systems, need for physical space and limited staff dedicated to providing treatment. Facilitators to implementation included outer setting characteristics (e.g., insurance coverage for tobacco treatment services) and process characteristics, including presence of a program champion and support from external change agents such as NCI. Conclusions: Obtaining leadership and staff buy-in, allocating resources to support IT and workflow integration, and hiring and retaining tobacco treatment specialists were key determinants of successful implementation across C3I centers. These multilevel factors that influenced implementation across a diverse set of NCI-Designated Cancer Centers in C3I can guide NCI, other cancer centers, and community oncology practices in successful implementation of tobacco dependence treatment programs and enhance patient outcomes.
Keywords: Tobacco Dependence Treatment Programs; Implementation Science; Cancer Survivors