Sustainability Module

This module provides a range of recommendations and strategies to help teams sustain tobacco treatment programs (TTPs) and consists of four sections:

• Sustainability Capacity
• Sustainability Strategies
• Financing Strategies
• Evaluation & Impact

Tobacco use is a chronic, relapsing condition, and TTPs must be sustained to support repeated cycles of care and provide lasting benefit to patient populations. Sustainability considerations should inform all stages of program implementation, starting with pre-implementation planning. 

The material that follows is designed to help support program sustainment. The resources offered are suggestions, not an exhaustive “must-do” checklist; select and modify strategies from the range of sustainability recommendations offered in this module to fit the particular context and needs of your setting. Sustainment can be a daunting task, but even the smallest steps can make an impact. These resources can help you get started and adapt as you go.

Sustaining TTPs requires:

• Maintaining key functions of a TTP—screening and treatment—over time
• Adapting implementation processes to meet changing contexts in the clinic, healthcare organization, and broader sociopolitical system
• Ongoing evaluation of program outcomes 

Long-term sustainment remains a critical challenge for TTPs. These sustainability challenges are heightened in settings with limited resources and for populations that current practices rarely reach, so it is crucial to plan for sustainment when designing your program. Sustaining interventions can foster trust and enhance their population impact. A commitment to health equity must be a long-term commitment. See the Health Equity Module for tools and strategies to prioritize health equity from pre-implementation to sustainment.

The conditions necessary to sustain interventions and maintain their benefits represents a gap in healthcare research (Cancer Center Cessation Initiative Sustainability Working Group, 2021). A new study led by Dr. Ramzi Salloum of the University of Florida is investigating the sustainability of tobacco cessation programs at NCI-designated cancer centers. The outcomes of this study will be used to develop a generalizable model for sustaining TTPs and will enhance knowledge in this field.