Screening Tools and Workflows

Tobacco use changes over time and should be assessed frequently throughout cancer care continuum.

Screening for tobacco involves asking patients about their tobacco use and may also involve biochemical testing for signs of tobacco use.

ASK: Screener for Current Tobacco Use

“In the past 30 days, have you smoked cigarettes or used any other forms of tobacco (cigars, pipe, smokeless tobacco, electronic cigarettes)?”

• Every day
• Some days
• Not at all

Workflows

Epic Workflow (includes workflows that use existing Epic tobacco history tools with options that include tobacco screening in vital signs or a custom-built alert)

Cerner Workflow (includes workflow that uses existing Cerner tobacco history tools)

General screening and treatment workflow for new and for established cancer patients

California Quits swimlane diagram depicting tobacco screening and treatment roles and workflows (p. 7)

University of Wisconsin Carbone Cancer Center protocol with centralized screening to fit multiple cancer care workflows.

EHR Tools

Screening tools:

• C3I Build Guide for Smoking Cessation Electronic Health Record Functionalities and Workflows for the Oncology Setting
  • Cerner Version (pp. 8-9)
  • Epic Version (p. 5)
• CDC Million Hearts Package (p. 14)
• University of Wisconsin Carbone Cancer Center protocol (p.1-3)

Customized alerts:

• Sample EHR alert that prompts staff to assess tobacco use and order a nicotine dependence consult and diagnosis (Fig 1)
  • Alert logic describing criteria for the EHR alert above to fire for clinic staff (Appendix A)
• Sample EHR alert to assess tobacco use and exposure and order consult to tobacco treatment service if any exposure is reported

Tobacco use assessments for in-house treatment:

• Warren et al., 2013 (Table 1)
• American Society of Clinical Oncology Tobacco Cessation Guide for Oncology Providers (pp. 23-24)
• The Cancer Patient Tobacco Use Questionnaire (C-TUQ) was designed for clinical research applications, but it may be a useful reference for tobacco use assessment.