Using information technology to integrate tobacco use treatment in routine oncology care: Lessons learned from the U.S. Cancer Center Cessation Initiative Cancer Centers

Jennifer E Bird; Claire Vt Nguyen; Sarah D Hohl; Heather D'Angelo; Danielle Pauk; Robert T Adsit; Michael Fiore; Mara Minion; Danielle McCarthy; Betsy Rolland

doi:10.1177/26334895231185374

Using information technology to integrate tobacco use treatment in routine oncology care: Lessons learned from the U.S. Cancer Center Cessation Initiative Cancer Centers

Implement Res Pract. 2023 Jul 7:4:26334895231185374. doi: 10.1177/26334895231185374. eCollection 2023 Jan-Dec.

Authors

Jennifer E Bird¹, Claire Vt Nguyen¹, Sarah D Hohl¹, Heather D'Angelo¹, Danielle Pauk¹, Robert T Adsit^{1

2}, Michael Fiore^{1

2

3}, Mara Minion¹, Danielle McCarthy^{1

2

3}, Betsy Rolland^{1

4}

Affiliations

¹ Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
² Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
³ Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁴ Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.

Abstract

Background: Cancer patients who receive evidence-based tobacco-dependence treatment are more likely to quit and remain abstinent, but tobacco treatment programs (TTPs) are not consistently offered. In 2017, the U.S. National Cancer Institute, through the Cancer Moonshot, funded the Cancer Center Cessation Initiative (C3I). C3I supports 52 cancer centers to implement and expand evidence-based tobacco treatment in routine oncology care. Integration into routine care involves the use of health information technology (IT), including modifying electronic health records and clinical workflows. Here, we examine C3I cancer centers' IT leadership involvement and experiences in tobacco-dependence treatment implementation.

Method: This qualitative study of C3I-funded cancer centers integrated data from online surveys and in-person, semistructured interviews with IT leaders. We calculated descriptive statistics of survey data and applied content analysis to interview transcripts.

Results: Themes regarding IT personnel included suggestions to involve IT early, communicate regularly, understand the roles and influence of the IT team, and match program design with IT funding and resources. Themes regarding electronic health record (EHR) modifications included beginning modifications early to account for long lead time to make changes, working with IT to identify and adapt existing EHR tools for TTP or designing tools that will support a desired workflow developed with end-users, and working with IT personnel to make sure TTPs comply with system and state policies (e.g., privacy laws).

Conclusions: The experiences of C3I cancer centers regarding the use of health IT to enhance tobacco-dependence treatment program implementation can guide cancer centers and community oncology practices to potentially enhance TTP implementation and patient outcomes.

Keywords: cancer; electronic health record; information technology; qualitative; tobacco.

Plain language summary

Almost a quarter of patients first diagnosed with cancer report current cigarette smoking. There are tobacco treatment programs (TTPs) that effectively help patients quit smoking to improve cancer treatment response, survival, and quality-of-life. In 2017, the U.S. National Cancer Institute (NCI) funded the Cancer Center Cessation Initiative (C3I) and supported 52 cancer centers to implement these TTPs. A key component of these programs is the information technology (IT) necessary to refer patients to the program and document their progress. As coordinators of C3I, our team conducted interviews with IT leaders at these cancer centers to learn about the implementation of the programs. IT leaders suggested that IT teams be involved early in the program implementation process and that leaders communicate with the IT team regularly to address necessary changes to referral and documentation systems. IT teams are important to involve early and regularly throughout the TTP implementation process because they have unique knowledge of how funding, policy, and existing technological tools will impact the implementation and success of the program. Our findings emphasize the importance of involving IT teams early in the planning process for such programs. Studies such as this focusing on the experiences and knowledge of specific team members, such as the IT team, enhance tobacco-dependence treatment program implementation and can guide cancer centers and community oncology practices to implement these programs to improve patient outcomes.