Pragmatic Application of the RE-AIM Framework to Evaluate the Implementation of Tobacco Cessation Programs Within NCI-Designated Cancer Centers

D’Angelo, Heather; Ramsey, Alex T.; Rolland, Betsy; Chen, Li Shiun; Bernstein, Steven L.; Fucito, Lisa M.; Hooper, Monica Webb; Adsit, Robert; Pauk, Danielle; Rosenblum, Marika; Cinciripini, Paul M.; Joseph, Anne M.; Ostroff, Jamie S.; Warren, Graham; Fiore, Michael C.; Baker, Timothy B.

doi:10.3389/fpubh.2020.00221

Cited by 32 publications

(35 citation statements)

References 22 publications

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“…7 Cancer centers have increased the reach of smoking cessation treatment programs primarily by integrating treatment into clinical workflows through the electronic health record (EHR). [8][9][10][11] However, given existing disparities in tobacco use, cessation treatment, and cancer treatment outcomes, 12,13 it is important to ensure that cessation treatment programs are not only expanded, but equitable in their reach to all patients.…”

Section: Introductionmentioning

confidence: 99%

Achieving Equity in the Reach of Smoking Cessation Services Within the NCI Cancer Moonshot-Funded Cancer Center Cessation Initiative

et al. 2021

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Background: Ensuring equitable access to smoking cessation services for cancer patients is necessary to avoid increasing disparities in tobacco use and cancer outcomes. In 2017, the Cancer Center Cessation Initiative (C3I) funded National Cancer Institute (NCI)-designated Cancer Centers to integrate evidence-based smoking cessation programs into cancer care. We describe the progress of C3I Cancer Centers in expanding the reach of cessation services across cancer populations. Methods: Cancer centers (n = 17) reported on program characteristics and reach (the proportion of smokers receiving evidence-based cessation treatment) for two 6-month periods. Reach was calculated overall and by patient gender, race, ethnicity, and age. Results: Average reach increased from 18.5% to 25.6% over 1 year. Reach increased for all racial/ethnic groups, and in particular for American Indian/Alaska Native (6.6-24.7%), Asian/Native Hawaiian/Pacific Islander (7.3-19.4%), and black (18.8-25.9%) smokers. Smaller gains in reach were observed among Hispanic smokers (19.0-22.8%), but these were similar to gains among non-Hispanic smokers (18.9-23.9%). By age group, smokers aged 18-24 years (6.6-14.5%) and > 65 years (16.1-24.5%) saw the greatest increases in reach. Conclusion: C3I Cancer Centers achieved gains in providing smoking cessation services to cancer patients who smoke, thereby reducing disparities that had existed across important subgroups. Taking a population-based approach to integrating tobacco treatment into cancer care has potential to increase reach equity. Implementation strategies including targeted and proactive outreach to patients and interventions to increase providers' adoption of evidence-based smoking cessation treatment may advance reach even further.

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Section: Introductionmentioning

confidence: 99%

Achieving Equity in the Reach of Smoking Cessation Services Within the NCI Cancer Moonshot-Funded Cancer Center Cessation Initiative

et al. 2021

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“…This gap in cancer care is being addressed by Lurie Cancer Center and 41 other cancer centers under the NCI Cancer Moonshot Cancer Center Cessation Initiative (C3I). Initial results from the C3I centers, including the current preliminary study by our center, show major gains in establishing integrated tobacco cessation programs and reaching and treating smokers with cancer [30][31][32][33][34][35][36][37]. These studies have also identified key leverage points, including workflow efficiency and leadership and stakeholder support of implementation [35] and EHR system modifications to facilitate tobacco use assessment and treatment referral and delivery [33,34,36].…”

Section: Discussionmentioning

confidence: 84%

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

May

Klass

Davis

et al. 2020

IJERPH

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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.

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“…Effectiveness was de ned as the number of current smokers at baseline who engaged in tobacco treatment and reported abstinence from smoking for at least 7 days, among responders at 6-month follow-up. Additional details about outcome measures are reported elsewhere [31].…”

Section: Outcome Measuresmentioning

confidence: 99%

“…Therefore, the C3I presents a unique opportunity to investigate the role and implication of costs to tobacco treatment program implementation and sustainability. Whereas early implementation success of the initiative has been recently reported [30,31], implementation costs in the C3I have not been examined.…”

Section: Introductionmentioning

confidence: 99%

Mixed-methods Economic Evaluation of the Implementation of Tobacco Treatment Programs in National Cancer Institute-designated Cancer Centers

Salloum

D’Angelo

Theis

et al. 2021

Preprint

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Background: The Cancer Center Cessation Initiative (C3I) was launched in 2017 as a part of the NCI Cancer Moonshot program to assist NCI-designated cancer centers in developing tobacco treatment programs for oncology patients. Participating centers have implemented varied evidence-based programs that fit their institutional resources and needs, offering a wide range of services including in-person and telephone-based counseling, point of care, interactive voice response systems, referral to the quitline, text- and web-based services, and medications.Methods: We used a mixed methods comparative case study design to evaluate system-level implementation costs across 15 C3I-funded cancer centers that reported for at least one six-month period between July 2018 and June 2020. We analyzed operating costs by resource category (e.g., personnel, medications) concurrently with transcripts from semi-structured key-informant interviews conducted during site visits. Personnel salary costs were estimated using Bureau of Labor Statistics wage data adjusted for area and occupation, and non-wage benefits. Qualitative findings provided additional information on intangible resources and contextual factors related to implementation costs.Results: Total monthly operating costs across funded centers ranged from $6,453 to $20,751. The largest operating cost category was personnel ($4,122-$19,794), with the highest personnel costs attributable to the provision of in-person program services. Monthly cost ranges for other categories were: medications ($17-$573), materials ($6-$435), training ($96-$516), technology ($171-$2,759), and equipment ($10-$620). Cost-per-participant ranged from $70 to $3,500 (median, $537) and cost-per-quit ranged from $330 to $9,799 (median, $2,699) with sites offering different combinations of program components, ranging from individually-delivered in-person counseling only to one program that offered all components. Site interviews provided context for understanding variations in program components and their cost implications.Conclusions: Among most centers that have progressed in tobacco treatment program implementation, cost-per-quit was modest relative to other prevention interventions. Although select centers have achieved similar average costs by offering program components of various levels of intensity, they have varied widely in program reach and effectiveness. Evaluating implementation costs of such programs alongside reach and effectiveness is necessary to provide decision makers in oncology settings with the important additional information needed to optimize resource allocation when establishing tobacco treatment programs.

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Pragmatic Application of the RE-AIM Framework to Evaluate the Implementation of Tobacco Cessation Programs Within NCI-Designated Cancer Centers

Cited by 32 publications

References 22 publications

Achieving Equity in the Reach of Smoking Cessation Services Within the NCI Cancer Moonshot-Funded Cancer Center Cessation Initiative

Achieving Equity in the Reach of Smoking Cessation Services Within the NCI Cancer Moonshot-Funded Cancer Center Cessation Initiative

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

Mixed-methods Economic Evaluation of the Implementation of Tobacco Treatment Programs in National Cancer Institute-designated Cancer Centers

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