Cancer. 2021 Dec 07; doi: 10.1002/cncr.34054. Epub 2021 Dec 07.
Using a multilevel implementation strategy to facilitate the screening and treatment of tobacco use in the outpatient urology clinic: A prospective hybrid type I study.
Cancer
Richard S Matulewicz, Jeffrey C Bassett, Lorna Kwan, Scott E Sherman, William J McCarthy, Christopher S Saigal, John L Gore
Affiliations
Affiliations
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
- VA New York Harbor Healthcare System, New York, New York.
- Hoag Urologic Oncology, Hoag Health Network, Newport Beach, California.
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
- Department of Population Health, New York University, New York, New York.
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
- Department of Psychology, University of California Los Angeles, Los Angeles, California.
- Department of Urology, University of Washington School of Medicine, Seattle, Washington.
PMID: 34875105
DOI: 10.1002/cncr.34054
Abstract
BACKGROUND: Urologists frequently treat patients for tobacco-related conditions but infrequently engage in evidence-based practices (EBPs) that screen for and treat tobacco use. Improving the use of EBPs will help to identify smokers, promote cessation, and improve patients' health outcomes.
METHODS: A prospective type I hybrid effectiveness-implementation study was performed to test the feasibility and effectiveness of using a multilevel implementation strategy to improve the use of tobacco EBPs. All urology providers at outpatient urology clinics within the Veterans Health Administration Greater Los Angeles and all patients presenting for a new urology consultation were included. The primary outcome was whether a patient was screened for tobacco use at the time of consultation. Secondary outcomes included a patient's willingness to quit, chosen quit strategy, and subsequent engagement in quit attempts.
RESULTS: In total, 5706 consecutive veterans were seen for a new consultation during the 30-month study period. Thirty-six percent of all visits were for a tobacco-related urologic diagnosis. The percentage of visits that included tobacco use screening increased from 18% (before implementation) to 57% in the implementation phase and to 60% during the maintenance phase. There was significant provider-level variation in adherence to screening. Of all screened patients, 38% were willing to quit, and most patients chose a "cold turkey" method; 22% of the patients elected referral to a formal smoking cessation clinic, and 24% chose telephone counseling. Among those willing to quit, 39% and 49% made a formal quit attempt by 3 and 6 months, respectively.
CONCLUSIONS: A strategy that includes provider education and a customized clinical decision support tool can facilitate provider use of tobacco EBPs in a surgery subspecialty clinic.
© 2021 American Cancer Society.
Keywords: cigarette smoking; implementation science; smoking cessation; urology
References
- Bernstein AP, Bjurlin MA, Sherman SE, Makarov DV, Rogers E, Matulewicz RS. Tobacco screening and treatment during outpatient urology office visits in the United States. J Urol. 2021;205:1755-1761. doi:10.1097/ju.0000000000001572 - PubMed
- Bjurlin MA, Cohn MR, Kim DY, et al. Brief smoking cessation intervention: a prospective trial in the urology setting. J Urol. 2013;189:1843-1849. doi:10.1016/j.juro.2012.11.075 - PubMed
- Bassett JC, Gore JL, Chi AC, et al. Impact of a bladder cancer diagnosis on smoking behavior. J Clin Oncol. 2012;30:1871-1878. doi:10.1200/jco.2011.36.6518 - PubMed
- Bassett JC, Gore JL, Kwan L, et al. Knowledge of the harms of tobacco use among patients with bladder cancer. Cancer. 2014;120:3914-3922. doi:10.1002/cncr.28915 - PubMed
- Bassett JC, Matulewicz RS, Kwan L, McCarthy WJ, Gore JL, Saigal CS. Prevalence and correlates of successful smoking cessation in bladder cancer survivors. Urology. 2021;153:236-243. doi:10.1016/j.urology.2020.12.033 - PubMed
- Matulewicz RS, Basak R, Zambrano I, et al. Patterns of current cigarette smoking, quit attempts, and cessation counseling among survivors of smoking related and non-smoking related urologic malignancies: a nationally representative cross-sectional analysis. J Urol. 2021;205:1444-1451. doi:10.1097/ju.0000000000001483 - PubMed
- Rink M, Crivelli JJ, Shariat SF, Chun FK, Messing EM, Soloway MS. Smoking and bladder cancer: a systematic review of risk and outcomes. Eur Urol Focus. 2015;1:17-27. doi:10.1016/j.euf.2014.11.001 - PubMed
- Sosnowski R, Bjurlin MA, Verze P, et al. Role of cigarette smoking in urological malignancies and clinical interventions for smoking cessation. Cent European J Urol. 2016;69:366-369. doi:10.5173/ceju.2016.883 - PubMed
- Cacciamani GE, Ghodoussipour S, Mari A, et al. Association between smoking exposure, neoadjuvant chemotherapy response and survival outcomes following radical cystectomy: systematic review and meta-analysis. J Urol. 2020;204:649-660. doi:10.1097/ju.0000000000000813 - PubMed
- Tellini R, Mari A, Muto G, et al. Impact of smoking habit on perioperative morbidity in patients treated with radical cystectomy for urothelial bladder cancer: a systematic review and meta-analysis. Eur Urol Oncol. 2021;4:580-593. doi:10.1016/j.euo.2020.10.006 - PubMed
- Gild P, Vetterlein MW, Seiler R, et al. The association of cigarette smoking and pathological response to neoadjuvant platinum-based chemotherapy in patients undergoing treatment for urinary bladder cancer-a prospective European multicenter observational study of the EAU Young Academic Urologists (YAU) Urothelial Carcinoma Working Group. Surg Oncol. 2020;34:312-317. doi:10.1016/j.suronc.2020.06.006 - PubMed
- Matulewicz RS, Makarov DV, Sherman SE, Birken SA, Bjurlin MA. Urologist-led smoking cessation: a way forward through implementation science. Transl Androl Urol. 2021;10:7-11. doi:10.21037/tau-20-1204 - PubMed
- Adams JM. Smoking cessation-progress, barriers, and new opportunities: the surgeon general's report on smoking cessation. JAMA. 2020;323:2470-2471. doi:10.1001/jama.2020.6647 - PubMed
- Shields PG. New NCCN guidelines: smoking cessation for patients with cancer. J Natl Compr Canc Netw. 2015;13(suppl):643-645. doi:10.6004/jnccn.2015.0191 - PubMed
- Shields PG, Herbst RS, Arenberg D, et al. Smoking cessation, version 1.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2016;14:1430-1468. doi:10.6004/jnccn.2016.0152 - PubMed
- Bjurlin MA, Goble SM, Hollowell CM. Smoking cessation assistance for patients with bladder cancer: a national survey of American urologists. J Urol. 2010;184:1901-1906. doi:10.1016/j.juro.2010.06.140 - PubMed
- Matulewicz RS, Bjurlin MA, Feuer Z, et al. A population-level assessment of smoking cessation following a diagnosis of tobacco- or nontobacco-related cancer among United States adults. J Smok Cessat. 2021;2021:6683014. doi:10.1155/2021/6683014 - PubMed
- Zhao C, Bjurlin MA, Roberts T, Rink M, Shariat SF, Matulewicz RS. A systematic review and scoping analysis of smoking cessation after a urologic cancer diagnosis. J Urol. 2021;205:1275-1285. doi:10.1097/ju.0000000000001641 - PubMed
- Bernstein SL, Weiss J, DeWitt M, et al. A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results. Implement Sci. 2019;14:8. doi:10.1186/s13012-019-0856-8 - PubMed
- McQueen L, Mittman BS, Demakis JG. Overview of the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI). J Am Med Inform Assoc. 2004;11:339-343. doi:10.1197/jamia.m1499 - PubMed
- Stetler CB, Mittman BS, Francis J. Overview of the VA Quality Enhancement Research Initiative (QUERI) and QUERI theme articles: QUERI series. Implement Sci. 2008;3:8. doi:10.1186/1748-5908-3-8 - PubMed
- Demakis JG, McQueen L, Kizer KW, Feussner JR. Quality Enhancement Research Initiative (QUERI): a collaboration between research and clinical practice. Med Care. 2000;38(suppl 1):I17-I25. - PubMed
- Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38:65-76. doi:10.1007/s10488-010-0319-7 - PubMed
- 2010 VHA Facility Quality and Safety Report. US Department of Veteran Affairs. Published October 2010. Accessed January 2, 2021. https://www.va.gov/health/docs/hospitalreportcard2010.pdf - PubMed
- Office of the Surgeon General. Smoking Cessation: A Report of the Surgeon General. US Department of Health and Human Services; 2020. Accessed January 2, 2021. https://www.hhs.gov/surgeongeneral/reports-and-publications/tobacco/2020-cessation-sgr-factsheet-keyfindings/index.html - PubMed
- Myrie AK, Matulewicz RS. Perceptions of the link between smoking and bladder cancer among United States adults. J Urol. 2021;205:324-326. doi:10.1097/ju.0000000000001415 - PubMed
- Nayan S, Gupta MK, Strychowsky JE, Sommer DD. Smoking cessation interventions and cessation rates in the oncology population: an updated systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2013;149:200-211. doi:10.1177/0194599813490886 - PubMed
- D'Angelo H, Hooper MW, Burris JL, et al. Achieving equity in the reach of smoking cessation services within the NCI Cancer Moonshot-funded Cancer Center Cessation Initiative. Health Equity. 2021;5:424-430. doi:10.1089/heq.2020.0157 - PubMed
- Burgess DJ, van Ryn M, Noorbaloochi S, et al. Smoking cessation among African American and White smokers in the Veterans Affairs health care system. Am J Public Health. 2014;104(suppl 4):S580-S587. doi:10.2105/ajph.2014.302023 - PubMed
- D'Angelo H, Rolland B, Adsit R, et al. Tobacco treatment program implementation at NCI cancer centers: progress of the NCI Cancer Moonshot-funded Cancer Center Cessation Initiative. Cancer Prev Res (Phila). 2019;12:735-740. doi:10.1158/1940-6207.capr-19-0182 - PubMed
- Croyle RT, Morgan GD, Fiore MC. Addressing a core gap in cancer care-the NCI Moonshot program to help oncology patients stop smoking. N Engl J Med. 2019;380:512-515. doi:10.1056/nejmp1813913 - PubMed
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