Team Roles

Cancer program and health system leaders

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Provide verbal support

Most C3I programs found that verbal support from leadership was a “foundational step” to securing buy-in across the health system (Hohl et al., 2022).

Stress program alignment with health system goals. Explicitly encourage adoption, set program benchmarks, and provide regular feedback in communications, meetings, and reports. 

Highlight that the tobacco treatment program can help the health system meet research and quality improvement criteria for 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). Set program benchmarks and quality improvement plans to align with these criteria.

C3I example: See Case Study C for a C3I program that utilized regular program communications from their Cancer Center Director to “shout out” program successes and reinforce engagement.

Provide tangible support

Secure resources needed for launching and sustaining the program (Hohl et al., 2022). Some may include:

  • Overall program funding
  • Cessation medication funding
  • Staff education and training
  • Equipment and office space
  • IT support and prioritization for EHR modifications 
  • Business intelligence prioritization for program report generation
  • Technology services, such as Interactive Voice Response (IVR)
  • Community outreach and engagement 
  • Marketing and communications
  • Incentives for adoption of the program and patient recruitment

C3I example: See Case Study M for a C3I center whose health system leaders secured funding and pharmacotherapy and expedited EHR modifications for the program.

Pay attention to the program

Meet regularly with tobacco treatment program leaders, and provide continuous support and feedback.

Tobacco treatment program leaders

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Build audit and feedback (A&F) interventions

Build audit and feedback (A&F) interventions to regularly report performance summaries to clinic and implementation teams.

Consider a theory-based Interactive and Participatory Audit and Feedback (IPAF) approach to collaboratively realign team behaviors with best practices and quality improvement goals (Ramly et al., 2021).

Solicit clinic and implementation team feedback regularly

C3I example: See Case Study L for a C3I program that gathered clinic team feedback to adapt screening and referral tools and enhance program implementation.

Measure patient satisfaction

Tobacco treatment can increase satisfaction with tobacco-related care and overall healthcare (Conroy et al., 2005).

Use feedback to adapt the program

Refine workflows, HIT tools, and reporting to support quality improvement.

Review quitline eReferral results and modify eReferral interfaces and training as needed (Zehner et al., 2022).

C3I example: See Case Studies F, L, and Q for C3I programs who modified and simplified EHR systems to address reported barriers and improve referral rates.

Regularly monitor and report program outcomes

See the Monitor Progress page for more information on when, how, and what to monitor.

Update leadership

Update cancer program and health system leaders about program impact, challenges, and resource needs. Highlight program alignment with health system and cancer program objectives.

Study the intervention

Consider opportunities to study the intervention in clinical research (see Case Studies F and L for C3I examples).

Implementers and support teams

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Develop tobacco use treatment expertise

Engage in tobacco treatment training, workshops, and communities of practice to develop expertise in treating tobacco use among patients with cancer or at risk for recurrence.

Train in the workflow

Train in the workflow for tobacco use assessment, referral, and treatment, particularly EHR tobacco status documentation and referral orders. Refer to the Pre-Implementation Module for step-by-step breakdowns of Sample Treatment Workflows.

Consider different training options to fit your organization. This example training presentation was designed to launch an internal referral treatment model program, in which treating clinicians were encouraged to provide brief point-of-care counseling prior to referral. Other training approaches may include:

  • Brief rationale for tobacco treatment presentations followed by direct computer-based workflow instruction
  • Organizationally distributed written guidance (mainly for EHR-based workflows)
  • Asynchronous video-based instructional presentations of why and how to engage in your tobacco treatment program

Promote the intervention as a standard of clinical care

Many teams are hesitant to adopt an intervention unless oncologists, surgeons, and clinical leaders explicitly support it. Provide education on the importance of tobacco cessation and model treatment referral and delivery.

See the Implementation Module Resources page and the Pre-Implementation Module Training page for additional resources.

Evaluate workflow implementation and program adoption

Solicit input from the entire clinic team, report barriers to referral and treatment, and advise program leaders on modifications and quality improvement.

Provide patient education

Inform patients of the impact tobacco cessation can have on their cancer care as well as the tobacco treatment options. Facilitate their engagement with the program.

See the Implementation Module Resources page for examples of patient education materials.