Quality improvement project to improve smoking cessation among an oncology cohort at a large US multistate cancer center.

435 Background: Assessing tobacco use and providing cessation support is recommended by the American Society for Clinical Oncology (ASCO). As part of the National Cancer Institute Cancer Center Cessation Initiative, we established an electronic health record based "opt-out" approach to refer patients to tobacco treatment specialists. However, the role of oncologists in contributing to the “opt-out” approach to patients has not been explored. We tested the hypothesis that a multi-component educational program for oncologists would increase the proportion of patients who completed tobacco treatment appointments. Methods: As a quality improvement initiative, oncology providers at the Rochester Mayo Clinic Cancer Center were educated using a multimodal academic detailing approach with group and individual educational sessions. Its effectiveness was tested using a modified step-wedge implementation design. The primary outcomes were patient behaviors that could plausibly be changed by conversations with their provider: the rate at which cancer patients identified as current tobacco users scheduled an appointment in the Nicotine Dependence Center, and the rate at which patients scheduled for a NDC appointment completed their appointment. Comparisons were made before, during, and after the education period (from July through Dec 2019) and with a separate group of providers who did not complete education (results examined over a similar time period). Results: Education intervention did not improve outcomes among providers who received education; indeed, the rate of appointment scheduling decreased, although this may reflect other concurrent changes in the tobacco treatment referral process (Table 1). Outcomes were similar between oncology providers who did and did not receive multicomponent education intervention. Conclusions: Smoking cessation efforts can be successfully integrated into routine cancer care. The implementation of the “opt-out” referral system resulted in approximately 1 in 5 patients being seen for tobacco use, but a multicomponent education intervention designed to equip oncologists to encourage patients to complete appointments was not effective. Novel approaches are needed to increase the uptake of tobacco treatment among patients.[Table: see text]