LeLaurin Jennifer H, Theis Ryan P, Dallery Jesse, Silver Natalie L, Markham Merry-Jennifer, Staras Stephanie A, Xing Chengguo, Shenkman Elizabeth A, Warren Graham W, Salloum Ramzi G
Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
Department of Psychology, University of Florida, Gainesville, FL, USA.
Implement Res Pract. 2022 Jan-Dec;3. doi: 10.1177/26334895221112153. Epub 2022 Jul 6.
The objective of this study was to determine how to optimize implementation of tobacco cessation treatment interventions in cancer care by (1) investigating the feasibility and acceptability of a multi-level approach to tobacco cessation treatment intervention, (2) identifying barriers and facilitators to implementation, and (3) eliciting additional strategies to improve implementation of the intervention.
We conducted qualitative interviews with oncologists ( = 15) from one large academic health center in the Southeastern United States. We asked about their knowledge, attitudes, and current practices regarding tobacco use screening and treatment. We also asked about two proposed strategies to support implementation of tobacco cessation treatment: (1) developing a registry of tobacco users in collaboration with the state-run tobacco cessation program, and (2) providing on-site tobacco cessation counseling from trained professionals.
Oncologists saw addressing tobacco use as valuable; however, they felt restricted from consistently addressing tobacco use by multi-level barriers such as workload, electronic health record (EHR) design, patient anxiety, and low self-efficacy for treating tobacco dependence. Oncologists responded positively to on-site treatment and felt this strategy would increase treatment accessibility and enhance engagement. Reaction to developing a registry of tobacco users was mixed, with concerns regarding lack of oncologist involvement and patient privacy expressed. Other suggested strategies for supporting implementation of tobacco cessation treatment included reducing referral complexity, establishing financial or quality incentives for oncologists, and leveraging existing EHR tools to facilitate integration of cessation interventions into clinic workflows.
We identified several challenges to implementing tobacco use treatment in cancer care; however, we considered strategies to overcome these barriers that were viewed as feasible and acceptable. Our work highlights the importance of engaging stakeholders in implementation efforts. Future work should explore the impact of the implementation strategies identified in this study.
本研究的目的是确定如何通过以下方式优化癌症护理中戒烟治疗干预措施的实施：（1）调查多层次戒烟治疗干预措施的可行性和可接受性；（2）识别实施过程中的障碍和促进因素；（3）引出其他改善干预措施实施的策略。
我们对美国东南部一家大型学术医疗中心的肿瘤学家（n = 15）进行了定性访谈。我们询问了他们关于烟草使用筛查和治疗的知识、态度和当前做法。我们还询问了两项支持戒烟治疗实施的拟议策略：（1）与州立戒烟项目合作建立烟草使用者登记册；（2）由经过培训的专业人员提供现场戒烟咨询。
肿瘤学家认为解决烟草使用问题很有价值；然而，他们感到受到多层次障碍的限制，无法始终如一地解决烟草使用问题，这些障碍包括工作量、电子健康记录（EHR）设计、患者焦虑以及治疗烟草依赖的自我效能低下。肿瘤学家对现场治疗反应积极，并认为该策略将提高治疗的可及性并增强参与度。对建立烟草使用者登记册的反应不一，有人对肿瘤学家缺乏参与和患者隐私表示担忧。其他支持戒烟治疗实施的建议策略包括降低转诊复杂性、为肿瘤学家建立财务或质量激励措施，以及利用现有的电子健康记录工具促进戒烟干预措施融入临床工作流程。
我们确定了癌症护理中实施烟草使用治疗的几个挑战；然而，我们考虑了克服这些被认为可行和可接受的障碍的策略。我们的工作强调了让利益相关者参与实施工作的重要性。未来的工作应该探索本研究中确定的实施策略的影响。
