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  OA09 - Lung Cancer: A Preventable Disease? (ID 134)

  • Event: WCLC 2019
  • Type: Oral Session
  • Track: Prevention and Tobacco Control
  • Presentations: 1
  • Now Available
  • Moderators:Bienvenido Barreiro, Carolyn Dresler
  • Coordinates: 9/09/2019, 11:00 - 12:30, Melbourne (1991)

  • 31239

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    OA09.07 - Implementing an Opt-Out Approach to Smoking Cessation Referrals for Cancer Patients in Ontario, Canada (Now Available) (ID 2728)

    11:00 - 12:30  |  Author(s): Naomi Schwartz
    • Abstract
    • Presentation
    • Slides

    Background
    

    Smoking is responsible for approximately 30% of all cancer deaths in Canada and more than 85% of lung cancer cases. Continued smoking results in decreased cancer treatment efficacy and safety, increased toxicities, greater risk of cancer recurrence and second primaries, poorer quality of life and decreased survival. Quitting smoking can reduce these adverse effects. In 2013, Cancer Care Ontario (CCO) implemented a smoking cessation program across 14 Regional Cancer Centres (RCCs) in the province of Ontario, Canada, employing a 3As (Ask, Advise, Act) brief intervention model.

    Method
    

    In the first few years of the program, smokers could “opt-in” to smoking cessation services by stating a readiness to quit. However, the provincial rate of smokers accepting support was low. In 2018, CCO adopted an “opt-out” approach, based on emerging evidence and feedback from an expert Advisory Committee. With this approach, healthcare providers (HCPs) automatically refer all smokers to a cessation service, without assessing the patient’s readiness to quit. Patients can refuse the referral if they choose. This program change was communicated to the RCCs through a revised program framework, site-specific action plans, and discussion during monthly knowledge exchange meetings with Regional Champions. Communications resources (posters and pocket cards) were created to support HCPs, with suggested scripts.

    Result
    

    The Accepted a Referral (proportion of smokers accepting referral to cessation services) performance metric was used to monitor program implementation. With an opt-in approach, the annual provincial rate of Accepted a Referral improved only slightly over three years (18.1% in 2015/16 to 22.5% in 2017/18). Just prior to launching the opt-out approach in Q3 of 2017/18, the provincial rate of Accepted a Referral was 23.3% (range 9.2% to 37.9% amongst 14 RCCs). One year later, the provincial rate had increased substantially to 31.9% (range 12.9% to 88.7%). Several RCCs showed dramatic increases, while others demonstrated little or no improvement.

    Conclusion
    

    In an effort to help more patients quit smoking and to achieve the best treatment outcomes possible, CCO adopted an opt-out approach to cessation referrals. Overall, there has been a substantial increase in the provincial rate of smokers accepting support, but implementation has varied amongst RCCs. Feedback indicates that while some HCPs found the approach relatively easy to implement, others have been resistant to change, expressing concern about the ethics of referring patients without assessing willingness to quit. Further research into the reasons behind the variable uptake of the opt-out approach will inform future implementation efforts.

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