Implementing a smoking cessation initiative in a cancer program: A quality improvement project.

Abstract

The University of Maryland Upper Chesapeake Health Center integrated a smoking cessation support into routine care for newly diagnosed cancer patients. This initiative was prompted by persistently higher smoking rates in Harford County compared with the state of Maryland and a concurrent reduction in local public health cessation resources. The project addressed identified gaps in provider-patient conversations regarding smoking status and readiness to quit. Aligned with the Commission on Cancer's Just ASK and Beyond ASK initiatives, smoking cessation was elevated as a primary treatment modality within the cancer program. The project focused on systematic identification, brief intervention, and referral. A standardized 2-question screening was embedded into the electronic medical record workflow for all new patients across multiple clinics, including the breast center, radiation oncology, and thoracic surgery. Medical assistants and nurses conducted screening during intake. Patients expressing readiness to quit received a "quit kit" containing educational materials, cessation aids, information on lung cancer screening, and referrals to the state Quitline services and on-site cessation classes. Follow-up phone calls from certified smoking cessation facilitators provided additional education and motivational support. The initiative achieved a 100% smoking status "ask rate" among 667 new patients, attributed to a mandatory electronic medical record hard stop. However, "assist rates" for active smokers varied over time, ranging from 35% to 54%. Of 111 identified smokers, 41 received cessation assistance. Post-project phone surveys indicated that more than half of patients who received quit kits reported reduced or discontinued tobacco use. Challenges included electronic medical record workflow limitations, delayed and manual data reporting, leadership turnover, competing clinical priorities, and the absence of a physician champion. Despite these barriers, strong executive support and cross-network collaboration facilitated progress. Ongoing efforts focus on optimizing electronic medical record functionality, strengthening staff education, and expanding dedicated cessation support to improve integration and outcomes.