Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 31, 2018
Open Peer Review Period: Aug 3, 2018 - Sep 13, 2018
Date Accepted: Dec 31, 2018
(closed for review but you can still tweet)
Implementation of a novel electronic patient directed smoking cessation platform for cancer patients: an interrupted time series analysis
ABSTRACT
Background:
Continued smoking in cancer patients undergoing treatment results in significantly higher rates of treatment toxicities and persistent effects, increased risk of recurrence and second malignancy, and increased all-cause mortality. Despite this, routine tobacco use screening and the provision of smoking cessation treatment has yet to be implemented widely in the cancer setting.
Objective:
The objective of this study was to implement and evaluate the adoption and impact of an innovative Smoking Cessation e-referral System (CEASE) to promote referrals to smoking cessation programs in cancer patients. The specific aims of the study were: 1) To facilitate the adoption of CEASE in promoting smoking screening and referral to cessation programs; and 2) To evaluate the impact of CEASE on screening and referral patterns.
Methods:
A patient directed electronic smoking cessation platform (Smoking Cessation e-referral System or CEASE) was developed to promote smoking screening and referral and implemented at one of Canada’s largest cancer centres. The implementation and evaluation was guided by the Ottawa Model of Research Use and RE-AIM framework. An interrupted time series design was used to examine the impact of CEASE on screening rates, referrals offered, and referrals accepted vs. a previous paper-based screening program. A sub-sample of smokers/recent quitters were also assessed and compared pre- and post- implementation to examine the effect of CEASE on subsequent contact with smoking cessation programs and quit attempts.
Results:
A total of 17,842 new patients attended clinics over the 20-month study time period. The CEASE platform was successfully implemented across all disease sites. Screening rates increased from 44.3% using the paper-based approach to 65.7% using CEASE (p<0.01) and referrals offered to smokers who indicated interest in quitting increased from 18.6% to 98.8% (p<0.01). Accepted referrals decreased from 41% to 20%, though the overall proportion of referrals generated from total current/recent tobacco users increased from 7.7% to 20.2%. At 1-month post screening, there was no significant difference in the proportion that was currently using tobacco and had not changed use in past 4 weeks (28.6% pre, 28.9% post). However, contact with the referral program increased from 0% to 78% in the post-CEASE cohort (p<0.001).
Conclusions:
CEASE is an innovative tool to improve smoking screening and allows for implementation in both a time- and cost-effective manner which promotes sustainability. CEASE was successfully implemented across all clinics and resulted in improvements in overall screening and referral rates and engagement with referral services. Clinical Trial: n/a
Citation
Per the author's request the PDF is not available.
Copyright
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