Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Support Care Cancer. 2019 Jun;27(6):2153-2158. doi: 10.1007/s00520-018-4486-5. Epub 2018 Oct 3.
Smoking is a risk factor for poor outcomes following breast reconstructive surgery. This project aimed to design and implement an intervention to consistently refer all breast cancer patients to tobacco treatment services.
In formative work, a set of processes for providers to consistently refer patients to a tobacco treatment specialist at the Nicotine Dependence Center (NDC) was designed. Elements included consistent documentation of smoking status, provider advice specific to the benefits of quitting to cancer care, referral to NDC using an "opt-out" strategy that emphasized smoking cessation as a standard part of breast cancer treatment, and reinforcement of the importance of the referral by multiple personnel. The number of referrals to the NDC and number of patients who attended their scheduled NDC appointment were measured before and 1 year after implementation. Qualitative evaluation was performed using semi-structured interviews with participating providers and patients regarding acceptability.
The proportion of smoking patients referred to the NDC increased from 29% (22/75) before the intervention to 74% (20/27) afterward. Among those referred, attendance at the consultation increased from 41% (9/22) to 75% (15/20). This occurred despite provider interviews revealing knowledge gaps about the referral process and evidence of provider adaptation to accommodate personal practice. Feasibility and acceptability of the intervention were high.
These findings suggest that similar referral interventions for all cancer patients should be pursued with the aim of embedding tobacco dependence treatment seamlessly and consistently into the cancer treatment plan of every patient who smokes cigarettes.
吸烟是乳房重建手术后不良结局的一个风险因素。本项目旨在设计并实施一项干预措施，以便将所有乳腺癌患者持续转介至烟草治疗服务机构。
在形成性工作中，设计了一套供医疗服务提供者用来持续将患者转介至尼古丁依赖中心（NDC）烟草治疗专家的流程。这些流程包括对吸烟状况进行持续记录、向患者提供与癌症治疗相关的戒烟益处的具体建议、使用“选择退出”策略转介至 NDC，该策略强调戒烟是乳腺癌治疗的标准组成部分，以及通过多个人力来加强对转介的重视。在实施之前和之后的 1 年，测量了转介至 NDC 的数量和参加 NDC 预约的患者数量。使用对参与提供者和患者进行的半结构化访谈，对可接受性进行定性评估。
接受转介至 NDC 的吸烟患者比例从干预前的 29%（22/75）增加到干预后的 74%（20/27）。在这些被转介的患者中，参加咨询的比例从 41%（9/22）增加到 75%（15/20）。尽管提供者访谈显示出对转介流程的知识差距，并证明了提供者为适应个人实践而进行的调整，但这一情况仍发生了。该干预措施具有较高的可行性和可接受性。
这些发现表明，应该为所有癌症患者开展类似的转介干预措施，旨在将烟草依赖治疗无缝且持续地纳入每位吸烟患者的癌症治疗计划中。
