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Cummings KM, Toll BA, Talbot V, Roberson A, Wilson D, Dunlap M, Ware EC, Palmer AM, Bliss AA, Anokye VS, Warren G. Implementation, enrollment, and engagement in an opt-out telehealth pharmacist-assisted tobacco treatment program for patients seen in oncology outpatient clinics. Cancer 2024; 130:2482-2492. [PMID: 38546445 PMCID: PMC11214603 DOI: 10.1002/cncr.35291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/07/2024] [Accepted: 02/29/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE To describe the workflow, reach, cost, and self-reported quit rates for an opt-out tobacco treatment program (TTP) for patients seen in 43 oncology outpatient clinics. METHODS Between May 25, 2021, and December 31, 2022, adult patients (≥18 years) visiting clinics affiliated with the Medical University of South Carolina Hollings Cancer Center were screened for smoking status. Those currently smoking were referred to a telehealth pharmacy-assisted TTP. An attempt was made to contact referred patients by phone. Patients reached were offered free smoking cessation counseling and a 2-week starter kit of nicotine replacement medication. A random sample of 420 patients enrolled in the TTP were selected to participate in a telephone survey to assess smoking status 4 to 12 months after enrollment. RESULTS During the reference period 35,756 patients were screened and 9.3% were identified as currently smoking. Among the 3319 patients referred to the TTP at least once, 2393 (72.1%) were reached by phone, of whom 426 (12.8%) were ineligible for treatment, 458 (13.8%) opted out of treatment, and 1509 (45.5%) received treatment. More than 90% of TTP enrollees smoked daily, with an average of 13.1 cigarettes per day. Follow-up surveys were completed on 167 of 420 patients, of whom 23.4% to 33.5% reported not smoking; if all nonresponders to the survey are counted as smoking, the range of quit rates is 9.3% to 13.3%. CONCLUSION The findings demonstrate the feasibility of reaching and delivering smoking cessation treatments to patients from a diverse set of geographically dispersed oncology clinics.
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Affiliation(s)
- K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Benjamin A. Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Avery Roberson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dianne Wilson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Martha Dunlap
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily C. Ware
- Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amanda M. Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Asia A. Bliss
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vincent S. Anokye
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Graham Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
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Yingst JM, Carrillo M, Chan KH, Choi K, Dao J, Kulkarni P, Bordner C, Goyal N, Foulds J, Bascom R. Effectiveness of smoking cessation interventions among persons with cancer: A systematic review. Psychooncology 2023; 32:1147-1162. [PMID: 37226331 DOI: 10.1002/pon.6171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Continued smoking after cancer diagnosis is associated with worse outcomes, however, many persons diagnosed with cancer who smoke are unable to quit successfully. Effective interventions are needed to promote quitting in this population. The purpose of this systematic review is to understand the most effective interventions for smoking cessation among persons with cancer and to identify gaps in knowledge and methodology to suggest directions for future research. METHODS Three electronic databases (The Cochrane Central Register of Controlled trials, MEDLINE, and EMBASE) were searched for studies of smoking cessation interventions among persons with cancer, published up to 1 July 2021. Title and abstract screening, full-text review, and data extraction was completed by two independent reviewers, via Covalence software, with any discordance resolved by a third reviewer. A quality assessment was completed using the Cochrane Risk of Bias Tool Version 2. RESULTS Thirty-six articles were included in the review, including 17 randomized-controlled trials (RCTs) and 19 non-RCT studies. Of the 36 studies, 28 (77.8%) utilized an intervention that included both counseling and medication, with 24 (85.7%) providing medication to participants at no cost. Abstinence rates in the RCT intervention groups (n = 17) ranged from 5.2% to 75%, while the non-RCTs found abstinence rates ranging from 15% to 46%. Overall, studies met a mean of 2.28 out of seven quality items, ranging from 0 to 6. CONCLUSIONS Our study highlights the importance of utilizing intensive combined behavioral and pharmacological interventions for persons with cancer. While combined therapy interventions seem to be the most effective, more research is needed, as current studies have several quality issues, including the lack of biochemical verification for abstinence.
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Affiliation(s)
- Jessica M Yingst
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Matthew Carrillo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Karen Choi
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
- Department of Otolaryngology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Joseph Dao
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Candace Bordner
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Neerav Goyal
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
- Department of Otolaryngology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Rebecca Bascom
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Ramsey AT, Baker TB, Stoneking F, Smock N, Chen J, Pham G, James AS, Colditz GA, Govindan R, Bierut LJ, Chen LS. Increased Reach and Effectiveness With a Low-Burden Point-of-Care Tobacco Treatment Program in Cancer Clinics. J Natl Compr Canc Netw 2022; 20:488-495.e4. [PMID: 35545172 PMCID: PMC9173433 DOI: 10.6004/jnccn.2021.7333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tobacco cessation after a cancer diagnosis can extend patient survival by improving outcomes for primary cancer and preventing secondary cancers. However, smoking is often unaddressed in cancer care, highlighting the need for strategies to increase treatment reach and cessation. This study examined a low-burden, point-of-care tobacco treatment program (ELEVATE) featuring an electronic health record-enabled smoking module and decision support tools to increase the reach and effectiveness of evidence-based smoking cessation treatment. METHODS This study included adult outpatient tobacco smokers (n=13,651) in medical oncology, internal medicine, and surgical oncology clinics from a large midwestern healthcare system. We examined reach and effectiveness of ELEVATE with 2 comparisons: (1) preimplementation versus postimplementation of ELEVATE and (2) ELEVATE versus usual care. Data were evaluated during 2 time periods: preimplementation (January through May 2018) and postimplementation (June through December 2018), with smoking cessation assessed at the last follow-up outpatient encounter during the 6 months after these periods. RESULTS The proportion of current tobacco smokers receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (1.6%-27.9%; difference, 26.3%; relative risk, 16.9 [95% CI, 9.8-29.2]; P<.001). Compared with 27.9% treatment reach with ELEVATE in the postimplementation time period, reach within usual care clinics ranged from 11.8% to 12.0% during this same period. The proportion of tobacco smokers who subsequently achieved cessation increased significantly from pre-ELEVATE to post-ELEVATE (12.0% vs 17.2%; difference, 5.2%; relative risk, 1.3 [95% CI, 1.1-1.5]; P=.002). Compared with 17.2% smoking cessation with ELEVATE in the postimplementation time period, achievement of cessation within usual care clinics ranged from 8.2% to 9.9% during this same period. CONCLUSIONS A low-burden, point-of-care tobacco treatment strategy increased tobacco treatment and cessation, thereby improving access to and the impact of evidence-based cessation treatment. Using implementation strategies to embed tobacco treatment in every healthcare encounter promises to engage more smokers in evidence-based treatment and facilitate smoking cessation, thereby improving care cancer for patients who smoke.
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Affiliation(s)
- Alex T. Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Timothy B. Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Faith Stoneking
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Jingling Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Giang Pham
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Aimee S. James
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Graham A. Colditz
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ramaswamy Govindan
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
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4
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Palmer AM, Rojewski AM, Nahhas GJ, Michael Cummings K, Warren GW, Toll BA. Associations between cancer diagnosis and patients' responses to an inpatient tobacco treatment intervention. Cancer Med 2021; 10:5329-5337. [PMID: 34197693 PMCID: PMC8335828 DOI: 10.1002/cam4.4082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diagnosis of a chronic illness, such as cancer may influence health behavior changes, such as smoking cessation. The present analyses examine associations between a cancer diagnosis (i.e., yes or no) and response to an opt-out smoking cessation bedside intervention provided to hospitalized patients. It was hypothesized that patients with a past or present cancer diagnosis would report higher motivation and engagement with quitting smoking, and higher rates of smoking abstinence after hospital discharge, compared to those without a cancer diagnosis. METHODS Chart review was conducted on 5287 inpatients who accepted bedside treatment from a counselor and opted-in to automated follow-up calls from July 2014 to December 2019. RESULTS At the time of inpatient assessment, those with a past or present cancer diagnosis (n = 419, 7.9%) endorsed significantly higher levels of importance of quitting than those without a cancer diagnosis (3.92/5 vs. 3.77/5), and were more likely to receive smoking cessation medication upon discharge (17.9% vs. 13.3%). Follow-up data from 30-days post-discharge showed those with a cancer diagnosis endorsed higher rates of self-reported abstinence (20.5%) than those without a cancer diagnosis (10.3%; p < 0.001). CONCLUSION Being hospitalized for any reason provides an opportunity for smokers to consider quitting. Having a previous diagnosis of cancer appears to increase intention to quit and lead to higher rates of smoking cessation in patients who are hospitalized compared to patients without cancer. Future research needs to work toward optimizing motivation for smoking cessation while admitted to a hospital and on improving quit rates for all admitted patients, regardless of diagnosis.
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Affiliation(s)
- Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.,Department of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Georges J Nahhas
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Graham W Warren
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Day AT, Dahlstrom KR, Lee R, Karam-Hage M, Sturgis EM. Impact of a tobacco treatment program on abstinence and survival rates among current smokers with head and neck squamous cell carcinoma. Head Neck 2020; 42:2440-2452. [PMID: 32476217 PMCID: PMC8691203 DOI: 10.1002/hed.26268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/14/2020] [Accepted: 05/05/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Approximately one quarter of head and neck cancer (HNC) patients smoke cigarettes at the time of diagnosis. Despite HNC guideline recommendations to treat tobacco dependence, the effectiveness of treatment in this population is poorly described. METHODS This retrospective cohort review evaluated 117 current smokers with p16-negative mucosal head and neck squamous cell carcinoma prospectively enrolled in a tobacco treatment program. Seven-day point prevalence tobacco abstinence rates at 9 months and survival outcomes were compared among abstinent and nonabstinent groups. RESULTS Median follow-up among survivors was 62.4 months. Forty percent of patients were abstinent at 9 months according to intention-to-treat analysis. After adjustment for age, comorbidity and site, abstinent stage I to II patients had a decreased risk of death compared to smoking stage I to II patients (HR 0.15, 95% CI 0.03-0.82). CONCLUSIONS High cohort abstinence rates and favorable survival among abstinent patients with early-stage HNC confirm the importance of tobacco dependence treatment in this population.
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Affiliation(s)
- Andrew T. Day
- Department of Otolaryngology—Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas
- Population Science & Cancer Control, UT Southwestern Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Kristina R. Dahlstrom
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rebecca Lee
- Department of Otolaryngology—Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Maher Karam-Hage
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M. Sturgis
- Population Science & Cancer Control, UT Southwestern Simmons Comprehensive Cancer Center, Dallas, Texas
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas
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May JR, Klass E, Davis K, Pearman T, Rittmeyer S, Kircher S, Hitsman B. Leveraging Patient Reported Outcomes Measurement via the Electronic Health Record to Connect Patients with Cancer to Smoking Cessation Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5034. [PMID: 32668758 PMCID: PMC7399884 DOI: 10.3390/ijerph17145034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/05/2020] [Accepted: 07/08/2020] [Indexed: 12/16/2022]
Abstract
Tobacco use negatively impacts cancer treatment outcomes, yet too few providers actively support their patients in quitting. Barriers to consistently addressing tobacco use and referring to treatment include time constraints and lack of knowledge surrounding treatment options. Patient Reported Outcomes (PRO) measurement is best practice in cancer care and has potential to help address these barriers to tobacco cessation treatment. This descriptive program evaluation study reports preliminary results following implementation of a novel automated PRO tobacco use screener and referral system via the electronic health record (EHR) patient portal (MyChart) that was developed and implemented as a part of a population-based tobacco treatment program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Between 25 June 2019 and 6 April 2020, 4589 unique patients completed the screener and 164 (3.6%) unique patients screened positive for recent (past month) cigarette smoking. All patients who screened positive were automatically referred to a smoking cessation treatment program integrated within the Lurie Cancer Center, and 71 (49.7%) patients engaged in treatment, as defined by completing at least one behavioral counseling session. Preliminary results indicate that the PRO/MyChart system may improve smoker identification and increase offering of treatment and, despite the "cold call" following a positive screen, may result in a treatment engagement rate that is higher than rates of treatment engagement previously documented in oncology settings. Longer term evaluation with formal statistical testing is needed before drawing conclusions regarding effectiveness, but PRO measurement via the EHR patient portal may serve a potentially important role in a multi-component approach to reaching and engaging cancer patients in comprehensive tobacco cessation treatment.
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Affiliation(s)
- Julia R. May
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA; (T.P.); (S.K.)
| | - Elizabeth Klass
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA; (T.P.); (S.K.)
| | - Kristina Davis
- Quality Innovation Center, Northwestern Medicine, Chicago, IL 60611, USA;
| | - Timothy Pearman
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA; (T.P.); (S.K.)
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Steven Rittmeyer
- Information Systems, Northwestern Medicine, Chicago, IL 60611, USA;
| | - Sheetal Kircher
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA; (T.P.); (S.K.)
| | - Brian Hitsman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA; (T.P.); (S.K.)
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Gali K, Pike B, Kendra MS, Tran C, Fielding-Singh P, Jimenez K, Mirkin R, Prochaska JJ. Integration of Tobacco Treatment Services into Cancer Care at Stanford. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062101. [PMID: 32235713 PMCID: PMC7143650 DOI: 10.3390/ijerph17062101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 01/08/2023]
Abstract
As part of a National Cancer Institute Moonshot P30 Supplement, the Stanford Cancer Center piloted and integrated tobacco treatment into cancer care. This quality improvement (QI) project reports on the process from initial pilot to adoption within 14 clinics. The Head and Neck Oncology Clinic was engaged first in January 2019 as a pilot site given staff receptivity, elevated smoking prevalence, and a high tobacco screening rate (95%) yet low levels of tobacco cessation treatment referrals (<10%) and patient engagement (<1% of smokers treated). To improve referrals and engagement, system changes included an automated "opt-out" referral process and provision of tobacco cessation treatment as a covered benefit with flexible delivery options that included phone and telemedicine. Screening rates increased to 99%, referrals to 100%, 74% of patients were reached by counselors, and 33% of those reached engaged in treatment. Patient-reported abstinence from all tobacco products at 6-month follow-up is 20%. In July 2019, two additional oncology clinics were added. In December 2019, less than one year from initiating the QI pilot, with demonstrated feasibility, acceptability, and efficacy, the tobacco treatment services were integrated into 14 clinics at Stanford Cancer Center.
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Affiliation(s)
- Kathleen Gali
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA; (K.G.); (B.P.); (P.F.-S.)
| | - Brittany Pike
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA; (K.G.); (B.P.); (P.F.-S.)
- Stanford Health Care, Stanford, CA 94305, USA; (C.T.); (R.M.)
| | - Matthew S. Kendra
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Cindy Tran
- Stanford Health Care, Stanford, CA 94305, USA; (C.T.); (R.M.)
| | - Priya Fielding-Singh
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA; (K.G.); (B.P.); (P.F.-S.)
| | - Kayla Jimenez
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, CA 94304, USA;
| | - Rachelle Mirkin
- Stanford Health Care, Stanford, CA 94305, USA; (C.T.); (R.M.)
| | - Judith J. Prochaska
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA; (K.G.); (B.P.); (P.F.-S.)
- Correspondence: ; Tel.: +1-650-724-3608
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