1 Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA.
2 Harvard Medical School, Boston, MA.
J Oncol Pract. 2019 Apr;15(4):e382-e388. doi: 10.1200/JOP.18.00593. Epub 2019 Mar 25.
Although continued tobacco use in patients who are treated with radiation therapy is associated with inferior outcomes and increased treatment-related toxicity, multiple studies have shown that current tobacco cessation efforts in oncology are insufficient. A quality improvement (QI) initiative was developed with the goal of improving tobacco cessation efforts in radiation oncology.
Using iterative plan-do-study-act cycles, barriers to tobacco cessation were identified and then addressed with a single-institutional QI initiative designed to improve physician assessment of patient readiness to quit tobacco by 50% or more. Residents assessed readiness to quit tobacco during new patient consultations and recorded this assessment in prespecified fields within the electronic health record. Feedback on assessment efforts was provided to our department via an automated search of the electronic health record.
From December 2014 to February 2015, before the initiation of the QI initiative, 4% of patients were assessed for their readiness to quit tobacco. After implementing the initiative, 67% of patients were assessed for their readiness to quit.
After instituting a QI initiative at our institution, significantly more patients were assessed for readiness to quit tobacco before treatment with radiation therapy. Ongoing efforts in our department are aimed at improving the efficacy of this intervention.
尽管在接受放射治疗的患者中继续吸烟与较差的结果和增加的治疗相关毒性有关，但多项研究表明，目前肿瘤学中的烟草戒断工作还不够充分。开展了一项质量改进（QI）计划，旨在改善放射肿瘤学中的烟草戒断工作。
通过迭代的计划-执行-研究-行动循环，确定了烟草戒断的障碍，然后通过一项旨在使医生评估患者戒烟准备情况提高 50%或更多的单机构 QI 计划来解决这些障碍。住院医师在新患者咨询期间评估患者戒烟的准备情况，并在电子病历中的预定字段中记录此评估。通过电子病历的自动搜索，向我们的部门提供评估工作的反馈。
从 2014 年 12 月至 2015 年 2 月，在开展 QI 计划之前，有 4%的患者接受了戒烟准备情况的评估。在实施该计划后，有 67%的患者接受了戒烟准备情况的评估。
在我们的机构实施 QI 计划后，在开始放射治疗前，有更多的患者接受了戒烟准备情况的评估。我们部门正在进行的努力旨在提高这一干预措施的效果。
