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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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Mossanen M, Smith AB, Onochie N, Matulewicz R, Bjurlin MA, Kibel AS, Abbas M, Shore N, Chisolm S, Bangs R, Cooper Z, Gore JL. Bladder cancer patient and provider perspectives on smoking cessation. Urol Oncol 2023; 41:457.e9-457.e16. [PMID: 37805339 DOI: 10.1016/j.urolonc.2023.08.017] [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: 03/07/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Smoking is the most common risk factor for bladder cancer and is associated with adverse clinical and cancer-related outcomes. Increasing understanding of the patient and provider perspectives on smoking cessation may provide insight into improving smoking cessation rates among bladder cancer survivors. We sought to inform strategies for providers promoting cessation efforts and help patients quit smoking. METHODS Using a modified Delphi process with multidisciplinary input from bladder cancer providers, researchers, and a patient advocate, 2 surveys were created for bladder cancer patients and providers. Surveys included multiple-choice questions and free answers. The survey was administered electronically and queried participants' perspectives on barriers and facilitators associated with smoking cessation. Survey responses were anonymous, and participants were provided with a $20 Amazon gift card for participating. Patients were approached through the previously established Bladder Cancer Advocacy Network (BCAN) Patient Survey Network, an online bladder cancer patient and caregiver community. Providers were recruited from the Society of Urologic Oncology (SUO) and the Large Urology Group Practice Association (LUGPA). RESULTS From May to June 2021, 308 patients and 103 providers completed their respective surveys. Among patients who quit smoking, most (64%) preferred no pharmacologic intervention ("cold turkey") followed by nicotine replacement therapy (28%). Repeated efforts at cessation commonly occurred, and 67% reported making more than one attempt at quitting prior to eventual smoking cessation. Approximately 1 in 10 patients were unaware of the association between bladder cancer and smoking. Among providers, 75% felt that barriers to provide cessation include a lack of clinical time, adequate training, and reimbursement concerns. However, 79% of providers endorsed a willingness to receive continuing education on smoking cessation. CONCLUSIONS Bladder cancer patients utilize a variety of cessation strategies with "cold turkey" being the most used method, and many patients make multiple attempts at smoking cessation. Providers confront multiple barriers to conducting smoking cessation, including inadequate time and training in cessation methods; however, most would be willing to receive additional education. These results inform future interventions tailored to bladder cancer clinicians to better support provider efforts to provide smoking cessation counseling.
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Affiliation(s)
- Matthew Mossanen
- Division of Urology, Brigham and Women's Hospital, Boston, MA; Department of Surgery, Center for Surgery and Public Health, Boston, MA; Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston MA.
| | - Angela B Smith
- Department of Urology, University of North Caroline at Chapel Hill School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Caroline at Chapel Hill, NC
| | | | - Richard Matulewicz
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marc A Bjurlin
- Department of Urology, University of North Caroline at Chapel Hill School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Caroline at Chapel Hill, NC
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Boston, MA
| | - Muhammad Abbas
- Department of Surgery, Center for Surgery and Public Health, Boston, MA
| | - Neal Shore
- GenesisCare, Carolina Urologic Research Center, Myrtle Beach, SC
| | | | - Rick Bangs
- GenesisCare, Carolina Urologic Research Center, Myrtle Beach, SC; Bladder Cancer Advocacy Network, Bethesda, MD
| | - Zara Cooper
- Department of Surgery, Center for Surgery and Public Health, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - John L Gore
- Department of Urology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
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Mazumdar P, Zavala G, Aslam F, Muliyala KP, Chaturvedi SK, Kandasamy A, Nizami A, Ul Haq B, Kellar I, Jackson C, Thomson H, McDaid D, Siddiqi K, Hewitt C, Siddiqi N, Gilbody S, Murthy P, Dadirai Mdege N. IMPACT smoking cessation support for people with severe mental illness in South Asia (IMPACT 4S): A protocol for a randomised controlled feasibility trial of a combined behavioural and pharmacological support intervention. PLoS One 2023; 18:e0287185. [PMID: 37315070 DOI: 10.1371/journal.pone.0287185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION The prevalence of smoking is high among people living with severe mental illness (SMI). Evidence on feasibility, acceptability and effectiveness of smoking cessation interventions among smokers with SMI is lacking, particularly in low- and middle-income countries. We aim to test the feasibility and acceptability of delivering an evidence-based intervention,i.e., the IMPACT smoking cessation support for people with severe mental illness in South Asia (IMPACT 4S) intervention that is a combination of behavioural support and smoking cessation pharmacotherapies among adult smokers with SMI in India and Pakistan. We will also test the feasibility and acceptability of evaluating the intervention in a randomised controlled trial. METHODS We will conduct a parallel, open label, randomised controlled feasibility trial among 172 (86 in each country) adult smokers with SMI in India and Pakistan. Participants will be allocated 1:1 to either Brief Advice (BA) or the IMPACT 4S intervention. BA comprises a single five-minute BA session on stopping smoking. The IMPACT 4S intervention comprises behavioural support delivered in upto 15 one-to-one, face-to-face or audio/video, counselling sessions, with each session lasting between 15 and 40 minutes; nicotine gum and/or bupropion; and breath carbon monoxide monitoring and feedback. Outcomes are recruitment rates, reasons for ineligibility/non-participation/non-consent of participants, length of time required to achieve required sample size, retention in study and treatments, intervention fidelity during delivery, smoking cessation pharmacotherapy adherence and data completeness. We will also conduct a process evaluation. RESULTS Study will address- uncertainty about feasibility and acceptability of delivering smoking cessation interventions, and ability to conduct smoking cessation trials, among adult smokers with SMI in low- and middle-income countries. CONCLUSIONS This is to inform further intervention adaptation, and the design and conduct of future randomised controlled trials on this topic. Results will be disseminated through peer-review articles, presentations at national, international conferences and policy-engagement forums. TRIAL REGISTRATION ISRCTN34399445 (Updated 22/03/2021), ISRCTN Registry https://www.isrctn.com/.
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Affiliation(s)
- Papiya Mazumdar
- Department of Health Sciences, University of York, York, United Kingdom
- School of Politics and International Studies, University of Leeds, Leeds, United Kingdom
| | - Gerardo Zavala
- Department of Health Sciences, University of York, York, United Kingdom
| | - Faiza Aslam
- Institute of Psychiatry, Rawalpindi, Pakistan
| | | | | | - Arun Kandasamy
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Asad Nizami
- Institute of Psychiatry, Rawalpindi, Pakistan
| | - Baha Ul Haq
- Institute of Psychiatry, Rawalpindi, Pakistan
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Cath Jackson
- Department of Health Sciences, University of York, York, United Kingdom
- Valid Research Ltd, Wetherby, United Kingdom
| | | | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Heslington, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, United Kingdom
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Heslington, United Kingdom
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, United Kingdom
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
- Hull York Medical School, Heslington, United Kingdom
| | - Pratima Murthy
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Cooper SL, Kovar V, Levinson AH. Developing a Collaborative, Team-Based Smoking Cessation Treatment Program in an Outpatient Oncology Setting. JCO Oncol Pract 2023; 19:e115-e124. [PMID: 36516366 PMCID: PMC10166398 DOI: 10.1200/op.22.00273] [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: 04/22/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Because clinical specialists often lack time and training to address secondary health issues such as smoking cessation, the National Cancer Institute Cancer Center Cessation Initiative (C3I) has mobilized cancer centers to develop systems for treating patients' tobacco dependence. METHODS One university-based cancer center was able to develop a program that formalized smoking treatment using a collaborative, multidisciplinary care team with overlapping expertise in cancer care, medication management, and tobacco cessation. Program planners delivered tobacco cessation services in the outpatient setting by automating identification of eligible patients using a tobacco registry in the electronic health records, directly involving oncology pharmacists in medication oversight, using dedicated tobacco treatment specialists to provide cessation services, and engaging oncologists through active communications protocols. Evaluators used Practical Robust Implementation and Sustainability Model as the guiding framework for a qualitative assessment of program development and implementation. Evaluators also measured provider satisfaction and utilization of services, program reach, and smoking cessation outcomes 6 months post enrollment. RESULTS During the evaluation period (July 1, 2018-September 30, 2019), the smoking cessation program engaged 96% of eligible patients (n = 214 of 223 eligible); 82% of those enrolled in the program (n = 183). At 6-month follow-up, 29.1% of enrolled patients self-reported 30-day point prevalence abstinence (n = 53) and 34.9% (n = 64) reported 7-day point prevalence abstinence (intent-to-treat rates). CONCLUSION Using a team-based approach that leverages individual expertise and interprofessional collaboration to provide patient-centered treatment, a smoking cessation program can identify and treat eligible patients in specialty clinics.
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Affiliation(s)
- Sara L. Cooper
- Department of Community and Behavioral Health, University of Colorado School of Public Health, Aurora, CO
| | - Vladka Kovar
- Department of Community and Behavioral Health, University of Colorado School of Public Health, Aurora, CO
| | - Arnold H. Levinson
- Department of Community and Behavioral Health, University of Colorado School of Public Health, Aurora, CO
- University of Colorado Cancer Center, Aurora, CO
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Groves S, McCutchan G, Quaife SL, Murray RL, Ostroff JS, Brain K, Crosbie PAJ, Yorke J, Baldwin D, Field JK, McWilliams L. Attitudes towards the integration of smoking cessation into lung cancer screening in the United Kingdom: A qualitative study of individuals eligible to attend. Health Expect 2022; 25:1703-1716. [PMID: 35514094 PMCID: PMC9327806 DOI: 10.1111/hex.13513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION There is limited research exploring how smoking cessation treatment should be implemented into lung cancer screening in the United Kingdom. This study aimed to understand attitudes and preferences regarding the integration of smoking cessation support within lung cancer screening from the perspective of those eligible. METHODS Thirty-one lung cancer screening eligible individuals aged 55-80 years with current or former smoking histories were recruited using community outreach and social media. Two focus groups (three participants each) and 25 individual telephone interviews were conducted. Data were analysed using the framework approach to thematic analysis. RESULTS Three themes were generated: (1) bringing lung cancer closer to home, where screening was viewed as providing an opportunity to motivate smoking cessation, depending on perceived personal risk and screening result; (2) a sensitive approach to cessation with the uptake of cessation support considered to be largely dependent on screening practitioners' communication style and expectations of stigma and (3) creating an equitable service that focuses on ease of access as a key determinant of uptake, where integrating cessation within the screening appointment may sustain increased quit motivation and prevent loss to follow-up. CONCLUSIONS The integration of smoking cessation into lung cancer screening was viewed positively by those eligible to attend. Screening appointments providing personalized lung health information may increase cessation motivation. Services should proactively support participants with possible fatalistic views regarding risk and decreased cessation motivation upon receiving a good screening result. To increase engagement in cessation, services need to be person-centred. PATIENT OR PUBLIC CONTRIBUTION This study has included patient and public involvement throughout, including input regarding study design, research materials, recruitment strategies and research summaries.
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Affiliation(s)
- Samantha Groves
- School of Health Sciences, Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Grace McCutchan
- Wales Cancer Research Centre, Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Samantha L. Quaife
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Rachael L. Murray
- Academic Unit of Lifespan and Population Health, Faculty of MedicineUniversity of NottinghamNottinghamUK
| | - Jamie S. Ostroff
- Memorial Sloan‐Kettering Cancer Center, Behavioral Sciences ServiceNew YorkNew YorkUSA
| | - Kate Brain
- Wales Cancer Research Centre, Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Philip A. J. Crosbie
- LydiaBecker Institute of Immunology and Inflammation, Division of Immunology, Immunity to Infection and Respiratory MedicineThe University of ManchesterWythenshaweUK
| | - Janelle Yorke
- School of Health Sciences, Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Christie Patient‐Centred Research, Division of Nursing, Midwifery and Social Work, The Christie NHS Foundation TrustThe University of ManchesterManchesterUK
| | - David Baldwin
- Department of Respiratory MedicineNottingham University Hospitals NHS TrustNottinghamUK
| | - John K. Field
- Institute of Systems, Molecular and Integrative Biology, Molecular and Clinical Cancer Medicine, Faculty of Health and Life SciencesUniversity of LiverpoolLiverpoolUK
| | - Lorna McWilliams
- School of Health Sciences, Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
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Pipe AL, Evans W, Papadakis S. Smoking cessation: health system challenges and opportunities. Tob Control 2022; 31:340-347. [PMID: 35241609 DOI: 10.1136/tobaccocontrol-2021-056575] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
Abstract
The systematic integration of evidence-based tobacco treatment has yet to be broadly viewed as a standard-of-care. The Framework Convention on Tobacco Control recommends the provision of support for tobacco cessation. We argue that the provision of smoking cessation services in clinical settings is a fundamental clinical responsibility and permits the opportunity to more effectively assist with cessation. The role of clinicians in prioritising smoking cessation is essential in all settings. Clinical benefits of implementing cessation services in hospital settings have been recognised for three decades-but have not been consistently provided. The Ottawa Model for Smoking Cessation has used an 'organisational change' approach to its introduction and has served as the basis for the introduction of cessation programmes in hospital and primary care settings in Canada and elsewhere. The significance of smoking cessation dwarfs that of many preventive interventions in primary care. Compelling evidence attests to the importance of providing cessation services as part of cancer treatment, but implementation of such programmes has been slow. We recognise that the provision of such services must reflect the realities and resources of a particular health system. In low-income and middle-income countries, access to treatment facilities pose unique challenges. The integration of cessation programmes with tuberculosis control services may offer opportunities; and standardisation of peri-operative care to include smoking cessation may not require additional resources. Mobile phones afford unique opportunities for interactive cessation programming. Health system change is fundamental to improving the provision of cessation services; clinicians can be powerful advocates for such change.
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Affiliation(s)
- Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - William Evans
- Department of Oncology, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Sophia Papadakis
- Clinic of Social and Family Medicine, University of Crete School of Medicine, Heraklion, Crete, Greece
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