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

项目总结/摘要 吸烟在肿瘤患者中既常见又治疗不足。虽然吸烟是一种主要的 吸烟会导致癌症，并导致更严重的癌症，只有一半的癌症患者吸烟 在癌症护理期间帮助戒烟，目前还不清楚他们提供的帮助是否有效。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 所有吸烟的癌症患者。电子健康记录（EHR）具有巨大的潜力， 通过促进这种治疗递送来改善临床护理。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， 帮助病人戒烟和改善癌症治疗效果。首席研究员拥有30年的经验 领导研究和政策努力，以促进吸烟的治疗。在过去的7年里，他领导了一个 开发和评估新的基于EHR的工具和工作流程的团队， 在初级保健中接受循证戒烟治疗的成年患者。全新R35 提案将同样确定增加吸烟治疗参与的干预策略， 在肿瘤护理中实施时的有效性。在过去的四年里，首席研究员 作为NCI登月计划支持的癌症中心戒烟计划（C3 I）的高级科学家， 52个国家癌症研究所指定的癌症中心开发和实施项目，以帮助他们的吸烟患者。然而， 这一极其重要的举措尚未得到系统的评估， 干预措施增强了吸烟计划的覆盖范围、患者参与度、实施、戒烟 有效性和效益。此次R35更新旨在通过系统评估最佳 通过EHR数据提取干预交付、医疗保健成本、短期癌症治疗的实践 总体结局和患者人口统计学。这些EHR数据将通过定性分析得到补充 混合方法中的C3 I吸烟治疗成分、实施、适应和背景。 高性能和低性能的吸烟治疗计划将被确定，然后将严格的方法， 用于从戒烟和成本效益的角度选择最佳实践方案。进一步 评估将确定实施战略和环境因素， 这些方案的有效性。这些计划的最佳做法将在绩效较低的 C3 I计划，在适应和实施方面得到研究团队的支持。务实的实施指南 和战略将被用来传播最佳做法，以癌症护理计划全国。因此 拟议的项目旨在扩展和适应变革性的EHR促进系统的变化， 从初级保健中的吸烟治疗到高度优先的癌症护理。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对癌症患者的益处。

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.