• Cancer

    “Opt-Out” Policy Increases Tobacco Treatment Visits Among Cancer Patients

Clinician investigators with Mayo Clinic Nicotine Dependence Center and Mayo Clinic Cancer Center report that automatically referring cancer patients to tobacco treatment services increases their use of this resource, while also increasing documentation of tobacco use status in the electronic health record.  Results of their pilot study were recently published in the International Journal of Environmental Research and Public Health.

The investigators designed a process using patient electronic health records to automatically identify and refer cancer patients who use tobacco to a tobacco treatment specialist. Supported by a best-practice advisory alert in the electronic health record, clinic staff handled the referrals and scheduled the tobacco treatment appointments while preparing patients to see a clinician. A co-signature from a clinician was not required. The research team piloted this process for six weeks starting in July 2019 at Mayo Clinic in Rochester, Minnesota.

During the pilot, clinic staff referred 210 oncology patients for tobacco use treatment. One hundred fifty, or 71%, of patients referred were scheduled for a tobacco treatment appointment. Twenty five, or 17%, of patients referred completed the appointment. While 25 may seem like a small number, it’s an improvement. In the six weeks prior to the pilot, just nine patients were scheduled for a tobacco treatment appointment and only four of those patients completed the appointment. These results demonstrate the feasibility of an electronic-health-record-based referral approach for tobacco use treatment that does not require active involvement from a clinician.

The best-practice advisory alert used in the pilot also increased documentation of patients’ tobacco use status.

A screen shot of the best-practice advisory alert used in the pilot study to prompt clinic staff to record tobacco use and refer patients for tobacco treatment.

“Although further work is needed to increase the number of patients who complete appointments, this EHR-based opt-out approach could be implemented in other specialties, further expanding the reach of tobacco use treatment in outpatient clinical practices,” says Thulasee Jose, M.D., lead author of the study and a research fellow at Mayo Clinic in Rochester.

This work was part of the National Cancer Institute (NCI) Cancer Center Cessation Initiative. Launched in 2017 as part of the NCI Cancer Moonshot program, the long-term goal of this initiative is to help cancer centers build and implement sustainable tobacco cessation treatment programs to routinely address tobacco cessation with cancer patients. Mayo Clinic joined the NCI Cancer Center Cessation initiative in 2018 when the NCI awarded the Nicotine Dependence Center a supplement to the Mayo Clinic Cancer Center’s NCI Cancer Center Support Grant, under the leadership of principal investigator, David O. Warner., M.D. 

For cancer patients, quitting tobacco is particularly important. "We know that people who have cancer will do better with regard to chemotherapy complications and radiation therapy complications. They’ll have less toxicity from those," says  J. Taylor Hays, M.D.,  study co-author and director of the Nicotine Dependence Center. "They’ll have better quality of life after their cancer treatment if they’re not smoking. They’ll have longer life."