Context: Comprehensive cancer center affiliated with an academic medical center that treats >20,000 oncology patients per year, roughly 63% of whom report current tobacco use. Piloted in the thoracic and lung clinic before expanding center-wide.
Tobacco Treatment Program target population: Outpatients and family members who currently use tobacco are eligible for tobacco treatment services.
Intervention: The program offers individual in-person counseling, pharmacotherapy, and referrals to the state quitline and a texting program.
Opt-out workflow: Nurse navigators meet with every new patient to establish a treatment plan, and they screen for tobacco use at these meetings. Patients who report tobacco use are automatically referred to tobacco treatment. Nurse navigators then reassess tobacco use during the delivery of a patient’s survivorship care plans at the end of their treatment. Rooming staff also assess tobacco use at every patient visit, and medical assistants, social workers, and providers can refer directly to the program. Referred patients are entered into a database, which a certified tobacco treatment specialist (TTS) uses to reach out and schedule treatment. Patient follow-up is conducted 6 months after treatment to assess effectiveness and re-engage in treatment as needed.
Challenges and solutions: The center serves a significant population of Spanish-speaking patients, so the program prioritized hiring a bilingual certified tobacco treatment specialist (TTS) who offers counseling in both English and Spanish.
With approval from their compliance director, the program established a contract with an external pharmaceutical company to ship nicotine replacement therapy (NRT) directly to patients.
In addition, the program piloted an adaptive automated SMS texting intervention to increase engagement and support abstinence. Tailored text messages are sent to patients in multiple series of four weeks until the patient enrolls in the program or for a maximum of twelve weeks. A similar tailored message series is sent to patients upon program completion to encourage abstinence and assess treatment effectiveness. The intervention resulted in increased patient satisfaction and decreased patient tobacco use.
Champions: Tobacco screening and treatment referrals were integrated with nurse navigation, as navigators meet with 100% of patients at the center at regular intervals. This allowed the program to expand center-wide quickly and significantly increase reach.