Pre-Implementation Module – New Standard

Design a way to ask about and document any cigarette smoking in the 30 days preceding a newly diagnosed patient’s first encounter or consultation with your cancer center. Patients should be documented in a structured format (i.e., as a discrete data element) as current (smoking in past 30 days), former (>30 days since smoked), or never smoking.

You can use or build on your existing tobacco screening procedures but should not rely on EHR data collected by others, as this may be incomplete or out of date. Instead, screening should occur at the initial patient encounter or consultation. Prior screenings do not meet the standard.

See Screening Tools and Workflows for ideas about how to do this.

Identify feasible and sustainable protocols that offer both behavioral counseling and pharmacotherapy to newly diagnosed patients with cancer within 30 days of their positive tobacco screening.

Just providing brochures with patient education to patients about how they can seek services or verbal suggestions without counseling will not meet the requirements. Standard 5.9 specifies the required elements of treatment and the multiple forms that counseling may take.

Both direct delivery of treatment within the cancer center and formal referral to an external treatment program will meet the standard for assistance. The CoC encourages programs to offer treatment within the cancer center rather than relying solely on external services to deliver treatment, however.

This Roadmap contains tools to deliver tobacco treatment at the point of care or via specialty tobacco treatment services or to refer to external services such as your state tobacco quitline or Smokefree.gov resources.

See Case Studies and Treatment Tools to adapt sample treatment protocols to fit the needs of your newly diagnosed patients who smoke.

Design your program to make conducting required annual audits of a minimum of 20 patients feasible and sustainable. This is best achieved through continuous improvement processes rather than relying on infrequent manual audits.

At a minimum, you will need to measure and report the following:

• Number of new patients screened.
• Number of new patients screened who reported current smoking (any cigarette smoking in the past 30 days).
• Number of new patients who reported current smoking who received or were referred to smoking cessation treatment.
  • Note: Patients who decline treatment are included as having been referred to treatment.

Design EHR tools to prompt and capture tobacco screening and assistance data in ways that can be queried in reports or dashboards at any time to improve the efficiency of audits. You can use such tools to track which of the smoking treatments you are offering actually reach patients, so you can assess if your treatments meet the standard in terms of offering both behavioral counseling and pharmacotherapy.

The Roadmap contains EHR build guides and samples of customized screening and other tools to deliver tobacco treatment at the point of care or via specialty tobacco treatment services or to refer to external services such as your state tobacco quitline or Smokefree.gov resources.

The proposed standardized data definitions in this publication can be used to improve measure effectiveness for tobacco use treatment (Shoenbill et al., 2025). See the Quality Improvement and Monitor Progress pages for more about designing your program for continuous improvement.

If your audit shows you are not meeting the standard by 2027, you will need a detailed and specific action plan.

The Roadmap offers best practice recommendations, case studies, a program planning tool, and sample screening and treatment workflows to help you  improve screening and treatment rates. It also offers samples of outreach, education, and training materials to help your team engage patients with cancer who smoke tobacco in treatment.

Quality improvement and monitoring progress resources may also help you to assess and refine your action plans.