Implementation of a Comprehensive Smoking Cessation Program in Cancer Care
Background: Quitting smoking after a cancer diagnosis minimizes treatment-related effects, improves prognosis, and enhances quality of life. However, smoking cessation services are not routinely integrated into cancer care. The Princess Margaret Cancer Centre implemented a digitally based Smoking Cessation Program (SCP) in oncology, leveraging an e-referral system (CEASE), to screen all new ambulatory patients, provide tailored education and advice on quitting, and facilitate referrals.
Methods: We adopted the Framework for Managing eHealth Change to guide implementation of the SCP by integrating six key elements: 1) Governance and leadership; 2) Stakeholder engagement; 3) Communication; 4) Work flow analysis and integration; 5) Monitoring and evaluation; and 6) Training and education.
Results: Incorporating elements of the Framework, we established a SCP with organizational and provincial accountability, through extensive stakeholder engagement and strategic partnerships. CEASE was integrated into existing electronic patient reported assessments. Clinic audits and staff engagement allowed for analysis of work flow, ongoing monitoring and evaluation aided in establishing a communication strategy and development of cancer-specific patient and healthcare provider education. From April 2016 to March 2018, 22,137 new patients were eligible for screening. Among those, 13,617 (62%) new patients were screened; 1,382 (10%) current smokers and 532 (4%) who recently quit within 6 months. Among those smokers or recently quit, all were advised to quit; 380 (20%) accepted referral to a smoking cessation counseling service.
Conclusions: This paper provides a comprehensive practice blueprint to implement digitally based SCPs as a standard of care within comprehensive cancer centers with high patient volumes.