Pre-Implementation Module – Best Practices

Best Practices: Integrating Tobacco Treatment in Healthcare

Tobacco treatment programs can help patients quit using tobacco and improve their cancer and other health outcomes. Tobacco treatment for patients can be delivered at the point of care, at the clinic, and through referrals to external treatment programs. This Roadmap provides sample screening, treatment, and referral workflows and tools that you can adapt for your clinical setting.

See our Case Studies for examples of successful programs.

Successful programs that address tobacco use share the following key features:

• They SCREEN all patients for tobacco use at regular intervals. They ask patients about tobacco use in an empathic and non-stigmatizing manner (Riley et al., 2017; Ostroff et al., 2022). Tobacco use is a chronic, relapsing condition, which requires repeated cycles of tobacco treatment care.
• They TREAT all patients who use tobacco with both pharmacotherapy and psychosocial support or counseling (Fiore et al., 2008; Leone et al., 2020; National Comprehensive Cancer Network, 2022; NCI, 2022). They design programs to minimize barriers to accessing treatment (An et al., 2016; Fu et al., 2016; Richter et al., 2016). Quitting can benefit all patients, including cancer patients in all stages of cancer care, and help people live longer.
• They are PROACTIVE rather than reactive. Programs that reach out to patients to offer tobacco treatment (by mail, EHR portal, phone, text messages, or during encounters) have a greater impact, and greater equity, than programs that rely on patients or clinicians to begin the conversation (Burris et al., 2022; Davis et al., 2020; Fu et al., 2016).

• Some programs make treating tobacco use the default rather than the exception using an OPT-OUT APPROACH, in which care teams initiate tobacco treatment for all patients who use tobacco unless the patient actively declines it (Ohde et al., 2021; Richter & Ellerbeck, 2015). There can be low rates of uptake when patients need to opt in to treatment. Making tobacco treatment the default standardizes reach, which can improve treatment for all patients (Bates-Pappas et al., 2024).

• They ENGAGE INTERESTED PARTIES in efforts to develop and implement SUSTAINABLE WORKFLOWS for tobacco screening and treatment (Cancer Center Cessation Initiative Sustainability Working Group, 2021). Engaging interested parties can increase program success in helping patients reduce tobacco use. Engaged leadership can delegate staff and resources to the tobacco treatment program; engaged IT and EHR teams can provide support for the workflow; engaged clinical staff can champion the program and encourage others to screen and treat patients; engaged patients can provide feedback and testimonials for improved reach and effectiveness of the program.
• They foster sustainability and quality improvement by developing workflows that allow them to COLLECT DATA on screening and treatment. These data facilitate ongoing performance feedback and refinement of workflows and implementation strategies (Cancer Center Cessation Initiative Sustainability Working Group, 2021; Ivers et al., 2012; Langley et al., 2009).
• They are designed to ensure they screen and treat ALL PATIENTS for tobacco use, including those at greatest risk of harm from tobacco use (Cancer Center Cessation Initiative Working Group Members, 2021; D’Angelo et al., 2021; NCI, 2022).