Effective and equitable tobacco treatment programs for cancer patients require ongoing assessment of both program processes (e.g., implementation strategies) and outcomes (e.g., treatment reach, effectiveness in terms of abstinence and cancer outcomes, and equity in these effects). This can help identify successes, challenges, and gaps in the pilot program and successive adaptations and expansions of the program. Ongoing monitoring can also generate feedback for stakeholders and implementers that can help enhance performance.
Engage both IT and business analytics experts in program development to ensure that the tobacco screening and documentation data can be pulled and analyzed to assess program performance. These experts can design tailored program monitoring and evaluation tools (e.g., dashboards, weekly program snapshots, automated monthly reports) in tandem with program interventions. See this general guidance on continuous quality improvement strategies.
- Number and proportion of cancer patients screened for tobacco among all adult cancer patients
- Number and proportion of cancer patients who used tobacco in the past 30 days
- Number and proportion of cancer patients who used tobacco in the past 30 days who were offered tobacco treatment by a program component
- Number and proportion of cancer patients who used tobacco in the past 30 days who initiated tobacco treatment
- Number and proportion of cancer patients who changed their tobacco use (operationalized primarily as self-reported abstinence from tobacco but perhaps also as at least 50% sustained reduction of tobacco use)
- Prevalence or severity of treatment toxicity, complication, side effects, cancer control, cancer recurrence, new primary cancers, and other clinical outcomes of interest
- Equity in the outcomes above across patient subgroups
You may choose to focus on evaluating the reach of your tobacco treatment programs rather than effectiveness in terms of abstinence or downstream clinical outcomes such as cancer survival. This was the primary dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (i.e., the RE-AIM) framework (Glasgow et al., 2018) emphasized in C3I (D’Angelo et al., 2020).
Your assessment strategy may vary depending on the scope of your program. You may just focus on a couple of clinics and limit data collection to these sites; you may adopt a broader scope and include survivors, family members, those with only second-hand exposure, etc.
Utilize Multiple Data Sources
You may need to rely on multiple data sources when monitoring your program. For example, it may be useful to use EHR data, but you may want to supplement this with tumor registry data, billing records, medication records, and reports from external treatment providers (e.g., quitlines). Particularly for tobacco abstinence data, establishing follow-ups by IVR or staff (e.g. TTS or nursing) can be valuable.
Align Assessment with Goals
You may also want to develop your reporting approach to meet both your quality improvement goals and reporting requirements of accreditation bodies such as the Joint Commission, the Commission on Cancer, or the National Accreditation Program for Breast Centers (e.g., the Beyond ASK program).