Leveraging the National Cancer Institute’s Cancer Center Cessation Initiative (C3I) Program to Evaluate and Transform Smoking Cessation Treatment in Cancer Care

利用国家癌症研究所的癌症中心戒烟倡议 (C3I) 计划来评估和转变癌症护理中的戒烟治疗

• 批准号: 10517948
• 负责人: MICHAEL C FIORE
• 金额: $ 86.19万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2029-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10517948
• 关键词: Adult; Cancer Center; Cancer Etiology; Cancer Patient; Cancer Prognosis; Cancer Survivor; Caring; Data; Effectiveness; Electronic Health Record; Health; Health Care Costs; Intervention; Malignant Neoplasms; Methods; Modification; NCI-Designated Cancer Center; National Cancer Institute; Oncology; Outcome; Patients; Policies; Primary Health Care; Principal Investigator; Program Effectiveness; Recovery; Research; Senior Scientist; Smoke; Smoking; Smoking Cessation Intervention; System; Treatment outcome; base; cancer care; cancer therapy; cigarette smoking; clinical care; contextual factors; cost; cost effectiveness; demographics; design; evidence base; experience; implementation strategy; improved; intervention delivery; patient engagement; pragmatic implementation; programs; smoking cessation; tool; treatment program

PROJECT SUMMARY/ABSTRACT Cigarette smoking is both common and undertreated among oncology patients. Although smoking is a leading cause of cancer and results in worse cancer prognoses, only half of cancer patients who smoke are offered help in quitting during cancer care, and it is unclear that the help they are offered is effective. This R35 proposal is designed to transform oncology practice so that smoking cessation is an integral part of treatment for all cancer patients who smoke. Electronic health records (EHRs) have tremendous potential to accelerate improvements in clinical care by facilitating such treatment delivery. EHR modifications can also increase discovery by enhancing assessment of smoking treatment reach, costs, equity, and effectiveness both in terms of helping patients quit and improving cancer outcomes. The Principal Investigator has 30 years of experience leading research and policy efforts to promote the treatment of smoking. Over the past 7 years, he has led a team that developed and evaluated new EHR-based tools and workflows that markedly increase the proportion of adult patients who receive evidence-based smoking cessation treatment in primary care. The new R35 proposal will similarly identify intervention strategies that increase smoking treatment engagement and effectiveness when implemented in oncologic care. Over the last 4 years, the Principal Investigator has served as Senior Scientist for NCI’s Moonshot-supported Cancer Center Cessation Initiative (C3I), a nationwide effort of 52 NCI-designated cancer centers to develop and implement programs to aid their patients who smoke. Yet, this incredibly important initiative has not been systematically assessed in terms of which EHR-enabled interventions enhance a smoking program’s reach, patient engagement, implementation, cessation effectiveness, and benefits. This R35 renewal is designed to do just that by systematically assessing best practices via EHR data extraction of intervention delivery, healthcare costs, short-term cancer treatment outcomes overall, and by patient demographics. These EHR data will be supplemented by qualitative analysis of C3I smoking treatment components, delivery, adaptations, and contexts in a mixed-methods approach. Higher- and lower-performing smoking treatment programs will be identified and rigorous methods will then be used to select best practice programs from cessation- and cost-effectiveness perspectives. Further assessment will identify implementation strategies and contextual factors that may contribute to the effectiveness of these programs. Best practices from these programs will be implemented in lower-performing C3I programs, with research team support in adaptation and implementation. Pragmatic implementation guides and strategies will be used to disseminate best practices to cancer care programs nationwide. Thus, the proposed project seeks to extend and adapt transformative EHR-facilitated system changes that enhance smoking treatment in primary care to the high-priority cancer care context. The project will demonstrate the benefits of such system changes to cancer patients in terms of costs, smoking cessation, and cancer recovery.

项目概要/摘要 吸烟在肿瘤患者中很常见，但治疗不足。虽然吸烟是一个主要 导致癌症的原因并导致癌症预后更差，只有一半的吸烟癌症患者接受治疗 在癌症治疗期间帮助戒烟，目前尚不清楚所提供的帮助是否有效。这R35 该提案旨在改变肿瘤学实践，使戒烟成为治疗的一个组成部分 对于所有吸烟的癌症患者。电子健康记录 (EHR) 具有巨大的加速潜力 通过促进此类治疗的实施来改善临床护理。 EHR 修改也可以增加 通过加强对吸烟治疗范围、成本、公平性和有效性的评估来发现发现 帮助患者戒烟并改善癌症结果。首席研究员拥有30年经验 领导促进吸烟治疗的研究和政策工作。过去7年里，他带领 开发和评估基于 EHR 的新工具和工作流程的团队显着提高了比例 在初级保健中接受循证戒烟治疗的成年患者的比例。新款R35 该提案将同样确定增加吸烟治疗参与度的干预策略，以及 在肿瘤护理中实施时的有效性。过去 4 年里，首席研究员曾担任 作为 NCI 登月计划支持的癌症中心戒烟计划 (C3I) 的高级科学家，这是一项全国性的努力 52 个 NCI 指定的癌症中心制定和实施项目来帮助吸烟患者。然而， 这项极其重要的举措尚未根据电子病历支持的方面进行系统评估 干预措施增强吸烟计划的影响范围、患者参与、实施和戒烟 有效性和好处。此次 R35 更新旨在通过系统地评估最佳性能来实现这一目标 通过 EHR 数据提取干预措施、医疗保健成本、短期癌症治疗的实践 总体结果以及患者人口统计数据。这些 EHR 数据将通过定性分析进行补充 以混合方法的方式研究 C3I 吸烟治疗的组成部分、实施、适应和背景。 将确定效果较好和效果较差的吸烟治疗方案，然后制定严格的方法 用于从戒烟和成本效益的角度选择最佳实践方案。更远 评估将确定可能有助于实现目标的实施战略和背景因素 这些计划的有效性。这些计划的最佳实践将在绩效较低的地区实施 C3I 项目，在研究团队的支持下进行调整和实施。务实的实施指南 将使用策略在全国范围内传播癌症护理计划的最佳实践。因此， 拟议的项目旨在扩展和适应电子病历促进的变革性系统变革，以增强 初级保健中的吸烟治疗到高度优先的癌症护理环境。该项目将展示 这种系统的改变在成本、戒烟和癌症康复方面给癌症患者带来了好处。