Study: Point of Care Approach to Tobacco Treatment Helps Cancer Patients Quit

Researchers examined the ways electronic health records and a new approach to tobacco cessation treatment could be used to help cancer patients quit smoking.

The results, published in Cancer Epidemiology, are promising: before the new approach, only 3.2% of people who smoke got treatment and only 12.4 percent actually quit; after, those numbers peaked at 48.2 percent and 21.4 percent respectively.

Point of care interventions work

While quitting smoking is far and away one of the best things a cancer patient can do, most oncology settings don’t take advantage of evidence-based smoking treatments. Limited resources and tight schedules keep providers from taking full advantage of quitting programs.

Any new program, then, needs to be immune to these issues; it should to be low-burden, robust, sustainable, unaffected by the rapidly changing conditions of a clinical setting. Enter: Point-of-care treatment.

“This really arose out of the experience of Li-Shiun Chen, Alex Ramsey, Ethan Craig, Laura Bierut and others at Washington University School of Medicine,” said Dr. Tim Baker, one of the researchers on the project. “They found that patients were hoping to receive tobacco treatment as part of their clinic visit, and that clinicians were quite receptive to intervening with patients who smoked if they had efficient tools to do so.

“Thus, patient interest and clinicians’ willingness to play an active role in helping their patients quit smoking led these researchers to develop an intervention program that emphasized direct clinician involvement with a team-care approach and electronic health record (EHR) support.”

When a patient expresses interest in tobacco treatment, the next steps usually involve setting up a future appointment where that patient can take advantage of coaching and medication. The issue is that fewer people were getting treatment; a lot of patients wouldn’t follow up on a referral.

Before this study began, across the 21 medical oncology clinics that participated, only 3.2 percent of people who smoke got any treatment at all.

The point-of-care model cuts out that extra step: it brings the cessation opportunities directly to the patient, whether or not they’ve made an extra appointment.

“There are multiple strengths of a point-of-care approach,” said Baker, “For one thing, it takes advantage of the patient being present at the clinical encounter. When a patient is referred to an external treatment resource, such as a quit line or smoking cessation specialist, it is unclear if they will actually connect with the resource—many times they do not.

“Also, the patient will often have a good relationship with their clinician. The clinician’s advice and intervention may have a lot of credibility, which could enhance effectiveness. Patients may also feel a greater obligation to follow through with treatment (such as taking their medication adherently) since they will expect the clinician will follow up with them.

“Finally, the clinician knows the patient better than would an outside counselor—this may allow for better treatment tailoring, such as choosing the right medication.”

If a smoker goes for a primary care visit, scheduled for some other reason, the point-of-care model would allow for the clinician to provide quitting resources right there and then.

This study, “Point of care tobacco treatment sustains during COVID-19, a global pandemic,” took the point-of-care model into 21 medical oncology clinics for 30 months. It sought to answer two questions: can this new approach improve the reach of tobacco treatment? Can it improve its effectiveness?

Reach was measured by how many people who smoke got access to any treatment at all, and the difference was more than a little noticeable.

As mentioned, at the start of the study only 3.2 percent of people who smoke got treatment, but after the 30 months a whopping 48.2 percent got access to valuable quitting aids, and that number was high throughout the entire study.

Effectiveness was measured by how many people who smoke quit smoking and stayed smoke free after the new model was implemented, and the results were also promising.

Before the new model, 12.4 percent of people who smoke quit and stayed smoke-free. In the first 12 months of the study, that number increased to 21.4 percent. Effectiveness dropped off in the later stages of the study; however, the results were always better than they were before the study started.

“I think that this work will lead other researchers and healthcare stakeholders to consider a point-of-care approach as a viable alternative to programs that focus on referral rather than on direct clinician involvement,” said Baker. “I think this also will lead researchers to explore the implementation strategies that the Wash U team developed to achieve high levels of treatment delivery by the participating clinicians and to achieve impressive sustainability in clinical effectiveness.”