Leveraging Patient Reported Outcomes Measurement via the Electronic Health Record to Connect Patients with Cancer to Smoking Cessation Treatment

Abstract

Tobacco use negatively impacts cancer treatment outcomes, yet too few providers actively support their patients in quitting. Barriers to consistently addressing tobacco use and referring to treatment include time constraints and lack of knowledge surrounding treatment options. Patient Reported Outcomes (PRO) measurement is best practice in cancer care and has potential to help address these barriers to tobacco cessation treatment. This descriptive program evaluation study reports preliminary results following implementation of a novel automated PRO tobacco use screener and referral system via the electronic health record (EHR) patient portal (MyChart) that was developed and implemented as a part of a population-based tobacco treatment program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Between 25 June 2019 and 6 April 2020, 4589 unique patients completed the screener and 164 (3.6%) unique patients screened positive for recent (past month) cigarette smoking. All patients who screened positive were automatically referred to a smoking cessation treatment program integrated within the Lurie Cancer Center, and 71 (49.7%) patients engaged in treatment, as defined by completing at least one behavioral counseling session. Preliminary results indicate that the PRO/MyChart system may improve smoker identification and increase offering of treatment and, despite the “cold call” following a positive screen, may result in a treatment engagement rate that is higher than rates of treatment engagement previously documented in oncology settings. Longer term evaluation with formal statistical testing is needed before drawing conclusions regarding effectiveness, but PRO measurement via the EHR patient portal may serve a potentially important role in a multi-component approach to reaching and engaging cancer patients in comprehensive tobacco cessation treatment.

Symptom and needs assessment screening in oncology patients: Alternate outreach methods during COVID-19

“…In-depth descriptions of the overall strategy used for PROMs at RHLCCC have been described previously. 7,13 Since June 2014, ePROs have been used for distress screening. Patients with qualifying ICD-10 codes listed in their problem list or visit diagnosis are sent PROMs 72 h prior to an appointment in the cancer center.…”

“…4 Use of patient-reported outcome measures (PROMs) is an effective way to screen for these needs and to facilitate the necessary clinical decision-making that occurs as a result of symptom identification. [5][6][7][8] Web-based symptom screening using PROMs has shown to be both acceptable to patients and oncology providers and to positively impact health outcomes. 9,10 PROMs help with needs assessment, shared decision-making, symptom management, and outcomes assessment.…”

“…14 As with other electronic PROs (ePROs), they allow care teams to remotely monitor symptoms and needs. 7,15 At the RHLCCC, automated alerts are generated to care team members for patient-endorsed care needs and moderate-to-severe symptoms.…”

Point of care tobacco treatment sustains during COVID-19, a global pandemic

“…Also, tobacco use may increase risk for developing severe illness and mortality associated with COVID-19 infection [ [3] , [4] , [5] ]. Despite the high need to prevent and treat these negative outcomes, evidence-based smoking cessation treatments in clinical settings are often underutilized due to provider barriers of time and resource constraints [ 2 , [6] , [7] , [8] ].…”

Tobacco Use and Treatment among Cancer Survivors

“…The findings from this study revealed that direct outreach had higher rates of referrals to and utilization of the cessation program compared with the other methods, and traditional referral had higher rates of program utilization compared with BPA. May and colleagues [30] evaluated the effectiveness of a patient-reported outcomes (PRO) tobacco use screener and automated referral system using a descriptive program evaluation design. The system was implemented through the patient portal of the electronic health record system of a cancer center and occurred concurrently with the launching of a provider-led referral system.…”