PDF(Pubmed)
Abstract：
Tobacco use among cancer patients is associated with an increased mortality and poorer outcomes, yet two-thirds of patients continue using following diagnosis, with disproportionately higher use among racial/ethnic minority and low socioeconomic status patients. Tobacco treatment services that are effectively tailored and adapted to population characteristics and multilevel context specific to settings serving diverse patients are needed to improve tobacco cessation among cancer patients. We examined tobacco use screening and implementation needs for tobacco treatment services to inform equitable and accessible delivery within a large comprehensive cancer center in the greater Los Angeles region. We conducted a multi-modal, mixed methods assessment using electronic medical records (EMR), and clinic stakeholder surveys and interviews (guided by the Consolidated Framework for Implementation Research). Approximately 45% of patients (n = 11,827 of 26,030 total) had missing tobacco use history in their EMR. Several demographic characteristics (gender, age, race/ethnicity, insurance) were associated with greater missing data prevalence. In surveys (n = 32), clinic stakeholders endorsed tobacco screening and cessation services, but indicated necessary improvements for screening/referral procedures. During interviews (n = 13), providers/staff reported tobacco screening was important, but level of priority differed as well as how often and who should screen. Several barriers were noted, including patients\' language/cultural barriers, limited time during visits, lack of smoking cessation training, and insurance coverage. While stakeholders indicated high interest in tobacco use assessment and cessation services, EMR and interview data revealed opportunities to improve tobacco use screening across patient groups. Implementing sustainable system-level tobacco cessation programs at institutions requires leadership support, staff training, on routine screening, and intervention and referral strategies that meet patients\' linguistic/cultural needs.
Implementation of equitable tobacco cessation services for diverse cancer patients will require understanding the specific needs and referral processes within health care setting context and target populations. In our study, we identified barriers to implementing a tobacco cessation program for diverse cancer patients (e.g., Asian/Asian American, Black/African American, Hispanic/Latino/a). Barriers noted by clinic team members to routine tobacco use screening and treatment included limited time during patient visits, lack of clinic team training on smoking cessation needs, language/cultural barriers for patients, and insurance coverage. Our findings showed health system leaders, providers, and staff agree that both tobacco use screening and providing tobacco cessation services are important, but there is a need for better understanding and improvement of clinic workflows, designated roles, and responsibilities of providers and staff, and increased awareness and training about tobacco use screening, available cessation services, and referral to treatment.
Implementation of equitable tobacco cessation services for diverse cancer patients will require understanding the specific needs and referral processes within health care setting context and target populations. In our study, we identified barriers to implementing a tobacco cessation program for diverse cancer patients (e.g., Asian/Asian American, Black/African American, Hispanic/Latino/a). Barriers noted by clinic team members to routine tobacco use screening and treatment included limited time during patient visits, lack of clinic team training on smoking cessation needs, language/cultural barriers for patients, and insurance coverage. Our findings showed health system leaders, providers, and staff agree that both tobacco use screening and providing tobacco cessation services are important, but there is a need for better understanding and improvement of clinic workflows, designated roles, and responsibilities of providers and staff, and increased awareness and training about tobacco use screening, available cessation services, and referral to treatment.
摘要：
癌症患者的烟草使用与死亡率增加和预后较差相关。然而，三分之二的患者继续使用以下诊断，在种族/族裔少数和社会经济地位低的患者中使用比例更高。需要有效定制和适应人群特征和特定于服务于不同患者的环境的多层次背景的烟草治疗服务，以改善癌症患者的戒烟。我们检查了烟草使用筛查和烟草治疗服务的实施需求，以告知大洛杉矶地区大型综合癌症中心内的公平和可访问的交付。我们进行了多模式，使用电子病历(EMR)的混合方法评估，和诊所利益相关者调查和访谈（由实施研究综合框架指导）。大约45%的患者(n=11,827/26,030)在他们的EMR中没有烟草使用史。几个人口统计学特征(性别，年龄,种族/民族,保险)与更高的缺失数据患病率相关。在调查中(n=32)，诊所利益相关者认可烟草筛查和戒烟服务，但指出了筛查/转诊程序的必要改进。在面试中（n=13），提供者/工作人员报告烟草筛查很重要，但优先级别不同，以及多久和谁应该筛选。注意到几个障碍，包括患者的语言/文化障碍，访问期间时间有限，缺乏戒烟培训，和保险范围。虽然利益攸关方对烟草使用评估和戒烟服务表示高度兴趣，EMR和访谈数据揭示了改善患者群体烟草使用筛查的机会。在机构实施可持续的系统级戒烟计划需要领导支持，员工培训,在常规筛查中，以及满足患者语言/文化需求的干预和转诊策略。
为不同癌症患者实施公平的戒烟服务将需要了解医疗保健环境和目标人群中的具体需求和转诊过程。在我们的研究中,我们确定了针对不同癌症患者实施戒烟计划的障碍(例如，亚洲/亚裔美国人，黑人/非洲裔美国人，西班牙裔/拉丁裔/a）。诊所小组成员注意到常规烟草使用筛查和治疗的障碍包括患者就诊时间有限，缺乏关于戒烟需求的诊所团队培训，患者的语言/文化障碍，和保险范围。我们的调查结果显示，卫生系统领导者，提供者,工作人员同意，烟草使用筛查和提供戒烟服务都很重要，但是需要更好地理解和改进临床工作流程，指定的角色,以及提供者和工作人员的责任，提高对烟草使用筛查的认识和培训，可用的戒烟服务，和转诊治疗。
为不同癌症患者实施公平的戒烟服务将需要了解医疗保健环境和目标人群中的具体需求和转诊过程。在我们的研究中,我们确定了针对不同癌症患者实施戒烟计划的障碍(例如，亚洲/亚裔美国人，黑人/非洲裔美国人，西班牙裔/拉丁裔/a）。诊所小组成员注意到常规烟草使用筛查和治疗的障碍包括患者就诊时间有限，缺乏关于戒烟需求的诊所团队培训，患者的语言/文化障碍，和保险范围。我们的调查结果显示，卫生系统领导者，提供者,工作人员同意，烟草使用筛查和提供戒烟服务都很重要，但是需要更好地理解和改进临床工作流程，指定的角色,以及提供者和工作人员的责任，提高对烟草使用筛查的认识和培训，可用的戒烟服务，和转诊治疗。
