Tobacco Treatment Program Planning Tool – Target Population

Consult with your clinic and HIT teams about how to identify new patients to screen for tobacco use. Questions to consider:

• How will you define a “new” patient (e.g., by visit type)? 
• Will you include patients who come to you for diagnosis and second opinion? 
• Will you include patients with new non-cancerous hematological diagnoses?  

Offering tobacco treatment soon after a cancer diagnosis can capitalize on patients’ strong motivation to quit using tobacco. It is important to remember that patients at all stages in cancer care can benefit from quitting tobacco.

See the American Society of Clinical Oncology Tobacco Cessation Guide for Oncology Providers (p. 23) and Table 1 in Warren et al., 2013, for tobacco use history questions that may be useful for new patients. Though the  Cancer Patient Tobacco Use Questionnaire (C-TUQ) was designed for clinical research applications, it may be a useful reference as well.

For established patients, think about how often you want to screen for tobacco use and offer treatment. Prompting these actions at every visit may be too often for some patients (e.g., those receiving daily radiation). However, addressing tobacco use only once at an initial visit will miss opportunities to engage with patients about their tobacco use. 

Programming suppression rules in the EHR for program-related alerts can help you set the periodicity for treatment activities (e.g., suppressing an alert for 90 days after a referral to treatment is placed or 30 days after treatment is declined). See sample EHR alerts for routine clinical encounters.

For survivors, relapse remains a risk and continued smoking raises the risk of new and recurrent cancers, so it is important to continue screening for tobacco use and offering treatment during survivorship. Remote treatments may be a good option for survivors because there are fewer barriers to accessing the treatment. See sample referral workflows for remote treatment programs.

For inpatients, you will find relevant resources in the CDC Million Hearts Change Package (inpatient resources are identified by the yellow triangle icon).

It is a great idea to involve patients’ families in tobacco screening and treatment if the patient wants this. Exposure to tobacco in the home increases risks of relapse and negative cancer outcomes. Support from family can also help patients quit using tobacco. See an article from the C3I Family and Social Support Systems Working Group here.

Consider whether you will need to enroll family members as new patients to provide them with tobacco treatment services or whether external resources, such as a quitline, can be offered.

Offering support in quitting tobacco to the broader community, beyond current patients and their families, is a great goal. Tobacco treatment outreach may enhance your community outreach and health goals. Here are aspects to consider:

• Will you offer direct care or promote existing resources available to community members (e.g., the state tobacco quitline, Smokefree.gov resources)?
• Who will pay for services?  Will this include free or reduced-cost medication?
• What is the capacity of your program?  Is there enough capacity to meet patient demand and offer community members support?
• How will you let the community know about the program and promote its use?  What resources do you need to do this?
• Will support and services be provided at your site or in the community?
  

See Case Study C for an example of a C3I program that extended to the community.

Helping your staff quit using tobacco may help you engage more tobacco treatment champions in efforts to treat tobacco use in cancer care. See Case Study C for an example of a C3I program that included treatment for staff.