Pre-Implementation Module – Why, When, and How

Why, When, and How to Screen for Tobacco Use and Exposure

Assessing and documenting tobacco use are critical first steps in a tobacco treatment program.

Why

Without sustained efforts to ensure tobacco use is assessed at intake and subsequent encounters, EHR data on tobacco are often incomplete. These inaccuracies can have negative consequences for cancer care (Khukareva et al., 2022).

When

Updating tobacco status over time can also help to assess the impact of your tobacco treatment program. For example, tracking conversions from current to former tobacco use among patients eligible for your treatment can help you assess program effectiveness (McCarthy et al., 2022).

Due to persistent risk of relapsing to tobacco use, all patients should continue to be screened and offered support throughout cancer diagnosis, treatment, and survivorship.

How

Because cancer patients who use tobacco may fear blame or stigma if they disclose tobacco use, it is important to train screening staff to ask about tobacco use in an empathic, non-judgmental manner (Riley et al., 2017; Ostroff et al., 2022). Using the EHR to prompt standardized screening can help. Consider patient experiences when developing this language.

Sample screening script:

We ask all our patients about tobacco use because we know that helping our patients reduce or quit using tobacco helps us treat their cancer. Let’s talk about your tobacco use. Have you used any form of tobacco, including e-cigarettes, in the past 30 days?