BACKGROUND
Tobacco use is a known factor in oncologic outcomes in Veterans. Lung cancer is not only the leading cause of cancer death in the U.S., but it is also more prevalent among Veterans. Tobacco use is underassessed and undertreated in healthcare settings. Newly diagnosed cancer patients seen at the Day-Treatment Center of Edward Hines Jr. VA Hospital were not consistently screened for tobacco use or appropriately referred to the hospital-based Tobacco Cessation Program.
PURPOSE
This quality improvement project was created to use existing resources to increase the percentage of newly diagnosed cancer patients screened for tobacco use based off the CoC Just ASK Quality Improvement Project and Clinical Study.
METHODS/DATA ANALYSIS
Using Plan-Do-Study- Act (PDSA) quality improvement methodology, a multidisciplinary team led by Oncology Nursing, Oncologists, Pharmacy, Social Work and Behavioral Health, to standardize processes to increase the percentage of tobacco use screening. The primary intervention was designating nurse educators to standardize the cancer treatment education process to include an assessment for tobacco by using the Just ASK criteria. The primary study goal was to increase tobacco use screening from 54.8% (Baseline Data) to 85% (Target State Goal).
RESULTS
Baseline number of tobacco screening in 2021 was 54.8%. From 1/1/22-6/30/22, 52.8% were screened using the Just ASK criteria. After the first PDSA cycle, from 7/1/22-12/31/22, tobacco screenings increased to 95.1%. PDSA cycle two revealed a 25% increase in Q1 accepting referrals. 62.5% of positive tobacco users agreed to accept care compared to 25% in PDSA cycle one.
CONCLUSIONS/IMPLICATIONS
The quality study met the primary goal of screening newly diagnosed cancer patients. The success of this project supported the use of existing VA hospital-based program resources such as educational materials, supportive medication, and behavioral counseling. Interventions directed at standardization of clinical workflow processes through nursing education and linkage to resources increased tobacco screening among newly diagnosed Veterans with cancer. Planned PDSA cycle two will spread standardized processes in the Rad/Onc Department and build capacity to offer smoking cessation assistance to newly diagnosed cancer patients who report as a current smoker. Annual VHA clinical reminders will be built in and satisfied by using an EMR tobacco screen template.
