Just ASK: A quality improvement project to enhance smoking assessment and treatment.

person Graham W. Warren Medical University of South Carolina, Charleston, SC info_outline Graham W. Warren, Jamie S. Ostroff, Timothy Mullett, Robert Adsit, Jessica Burris, Audrey Darville, Michael C. Fiore, Ellen Hahn, Laurie Kirstein, Danielle McCarthy, Heidi Nelson, Eileen Reilly, Rachel C Shelton, Elisa Tong

Authors person Graham W. Warren Medical University of South Carolina, Charleston, SC info_outline Graham W. Warren, Jamie S. Ostroff, Timothy Mullett, Robert Adsit, Jessica Burris, Audrey Darville, Michael C. Fiore, Ellen Hahn, Laurie Kirstein, Danielle McCarthy, Heidi Nelson, Eileen Reilly, Rachel C Shelton, Elisa Tong Organizations Medical University of South Carolina, Charleston, SC, Memorial Sloan Kettering Cancer Center, New York, NY, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, University of Wisconsin Center for Tobacco Research and Intervention, Madison, WI, University of Kentucky, Lexington, KY, University of Kentucky College of Nursing, Lexington, KY, College of Nursing and Public Health, University of Kentucky, Lexington, KY, University of Wisconsin School of Medicine and Public Health, Madison, WI, American College of Surgeons, Chicago, IL, Mailman School of Public Health, Columbia University, New York, NY, University of California Davis, Sacramento, CA Abstract Disclosures Research Funding U.S. National Institutes of Health U.S. National Institutes of Health Background: Persistent smoking after cancer diagnosis causes adverse clinical outcomes. ASCO and other organizations view smoking assessment and treatment as indicators of high-quality cancer care. Yet, adoption of clinical practice guidelines like the 3As (Ask, Advise and Assist) for smoking assessment and treatment has been slow and inconsistent in cancer care settings. Methods: Led by the American College of Surgeons Cancer Programs’ Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC), the “Just ASK” national quality improvement project focuses on enhancing smoking assessment and treatment in cancer care settings. All CoC/NAPBC programs (n~2000) were invited to participate, which consisted of educational webinars, online resources, and 3 online surveys (baseline, 6- and 12-month) collecting information on smoking assessment and treatment practices, plus other variables (e.g., organizational priority, implementation barriers). Program participation was incentivized by fulfillment of accreditation standards. Results: In total, 776 programs (731 CoC, 45 NAPBC), participated. At baseline, most programs strongly endorsed the importance of addressing smoking within cancer care and the majority of programs reported routinely assessing smoking (90%) and advising all patients reporting current smoking to quit (71%). However, routine delivery of evidence-based smoking cessation assistance (e.g., quitline referral, cessation medications, counseling services) was low (all < 30%). Program retention was excellent (91%). As shown in the table, the 12-month follow-up revealed marked improvements in evidence-based Ask, Advise and Assist, practices. Conclusions: At enrollment, the importance of addressing smoking was evident and high rates of smoking assessment were reported. At 12-month follow-up, marked improvement was reported in all quality indicators of the 3As. These findings guided the sharing of strategies for improving patient assessment, clinical workflow and documentation. Suboptimal delivery of smoking cessation assistance persisted despite overall improvements, which highlight persistent challenges and opportunities for implementing smoking assessment and treatment in cancer care settings. Assessment and Treatment Practices Baseline (n=776) Always or Usually 12-month follow up (n=703) Always or Usually Ask patients about smoking 696 (90%) 690 (98%) Advise patients to quit smoking 553 (71%) 588 (84%) Assist patients in quitting 323 (42%) 424 (60%) Provide self-help information 209 (27%) 395 (56%) Refer patients to Quitline 219 (28%) 367 (52%) Refer patients to tobacco treatment specialist in cancer program 204 (26%) 289 (41%) Provide individual counseling in person 141 (18%) 190 (27%) Prescribe FDA approved cessation medications 136 (18%) 179 (25%)