Treatment for All Patients Module
This module seeks to orient teams to key considerations to improve the design, implementation, and delivery of tobacco treatment for all patients in clinical care.
That said, these considerations should inform every aspect of this work (from pre-implementation to sustainment) to ensure all patient populations have access to quality care, so you will also find relevant guidance and resources integrated throughout the Roadmap and designated by the symbol on the left.
Certain patient populations face a disproportionate burden of tobacco-related cancers (National Cancer Institute, 2022). Differences in cancer prevention, early detection, and treatment outcomes across patient groups reflect this (Cancer Facts and Figures, 2023).
These socially driven differences are incompatible with perspectives on health that emphasize the following:
- All people should be valued equally, including all patients with cancer.
- Health has a particular value for individuals; this value and right is not defined by or relative to others’ value.
- All people have rights to health and to a standard of living adequate for health.
- All people can develop to their full potential without constraints of power or structure.
Addressing smoking as a leading determinant of cancer outcomes can help centers improve health for all patient populations.
To deliver tobacco treatment to all patients in health systems’ catchment areas, it is important to understand factors that contribute to tobacco-related health burdens and design programs to to eliminate or minimize them. These programs should address both risks (e.g., reduced access to healthcare) and protective factors (e.g., strong social kinship networks, faith, collectivism, cultural values) that modulate these differences (Williams et al., 2016). The Health Experiences Research Network’s Smoking and Cancer catalyst film shares patients’ experiences with smoking, cancer, and tobacco cessation, which can inform these efforts.
This toolkit provides key language, concepts, strategies, and guidance to get started with implementation research for all patients.
Roadmap Navigation
- Pre-Implementation Module
- Implementation Module
- Sustainability Module
- Treatment for All Patients Module
- Roadmap Toolkit
- Roadmap References
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Understanding the strengths of the patient populations most affected by tobacco in your community can inform your program planning. You can work with community partners to identify options to leverage strengths to overcome barriers and enhance the impact of your tobacco program.
For example, effective tobacco prevention and treatment campaigns for American Indian communities focus on keeping tobacco sacred and reclaiming traditional practices from commercial tobacco companies in an effort to promote health and preserve culture simultaneously. See more from the National Native Network, and Minnesota Blue Cross Blue Shield Center for Prevention.
In addition, some effective tobacco control messaging programs highlight the history of targeting, exploitation, and cultural appropriation of African-American/Black communities by tobacco companies. See more from the truth initiative and Public Health Law Center.
Prompting care teams to offer or deliver tobacco treatment to all patients appears to reduce health burdens among many population subgroups (Baker et al., 2021; Bates-Pappas et al., 2024; Creswell et al., 2022; McCarthy et al., 2022). This is important as differences in tobacco use prevalence, and its consequences in terms of cancer, have grown as tobacco use rates have declined overall (Irvin Vidrine et al., 2009; Simmons et al., 2016). Such differences are prominent in usual care conditions in which the onus is on individual patients or clinicians to request or initiate tobacco treatment (Babb et al., 2017).
Targeted tobacco treatment and education can help improve treatment for those disproportionately affected by tobacco use. Interventions that are culturally specific have been shown to improve knowledge, health behaviors, and health outcomes, especially when tailored at the patient level (Williams et al., 2016).
Examples of such programs include:
- Quitline services that provide culturally specific and intensified cessation services to clients who identify as American Indian or Alaska Native
- A video-and-text-based intervention that increases confirmed abstinence rates among African American adults with resource limitations, when compared against SmokefreeTXT (Webb Hooper et al., 2021)
- A self-help intervention for African American adults who smoke
- Strategies recommended in the American Lung Association guide Addressing Tobacco Use in Black Communities
- An Asian smoking quitline for people who identify as Asian or Asian American, with services available in Cantonese, Mandarin, Korean, Vietnamese, and English
- CDC-recommended strategies to overcome barriers reported by LGBTQ+ communities in stopping tobacco use and American Lung Association-recommended strategies to provide culturally specific tobacco treatment in LGBTQ+ communities and counter tobacco industry targeted marketing
- SmokefreeTXT programs for the general public, as well as specific populations including American Indians and Alaska Natives, veterans, teens, Spanish speakers, and pregnant women
- Texting, telehealth, and in-home support for pregnant and post-partum persons
- Interventions for behavioral health and substance use treatment clients
Based on demographic, diagnostic, and other health information you collect from patients, you could design system changes that match patients to specialized publicly available resources.
Interventions designed for individuals (i.e., patients), providers, health care organizations and systems, and communities offer viable options for addressing health differences through personalized behavior change, education, and policy (Williams et al., 2016). A range of interested parties should be engaged in designing your program to ensure various types of health differences are addressed and the program results in improved tobacco treatment reach and effectiveness. Consider engaging:
- Representatives from the populations of interest (i.e., “nothing about us without us”)
- Community advisory or advocacy boards
- Leaders in your system
- Front-line staff with experience and knowledge working with various groups
- Quality improvement and business analytics experts who can help you design methods (e.g., dashboards or automated reports) to monitor disparities
This team can help you build a program that will enhance cancer control for all patients. See these strategies for inclusive leadership and ways to enhance the healthcare workforce.