Educating Providers on Delivering Brief Tobacco Cessation Interventions to Cancer Patients

Abstract

Purpose: The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to identify barriers, increase knowledge, and improve self-efficacy for implementing brief tobacco cessation interventions among those caring for cancer patients at Tripler Army Medical Center (TAMC). Background: More than 500,000 individuals are diagnosed with tobacco related cancer in the Unites States each year, and one-fourth continue to use tobacco products after a diagnosis is made. Continued tobacco use increases the odds of cancer recurrence, furthers the risk of developing other cancers, and decreases the efficacy of cancer treatment. Tobacco use also increases the severity of treatment related side effects, which can lead to dose-reductions, interruption of treatment, and decreased survival. While interventions should be provided for all tobacco users, efforts should be especially aimed toward cancer patients. Current guidelines recommend using the 5 A’s model for tobacco cessation: Ask, Advise, Assess, Assist, Arrange. Methods: Those invited to participate in this project were members of the TAMC Cancer Committee, and included 80 providers, nurses, and support staff. Of those invited to participate, 65 were available to take part in the project. Participants were invited via email to complete a pre-intervention survey to evaluate perceptions, practices, knowledge, and barriers regarding delivery of tobacco cessation interventions. Ten days after the pre-intervention survey closed a second email was sent, which included a webinar with information on implementing the 5 A’s of tobacco cessation. At the conclusion of the webinar, a link to a post-intervention survey was provided. This survey assessed knowledge, perceptions, and changes in confidence related to the delivery of tobacco cessation interventions. Inclusion criteria were individuals who spend at least 25% of their time in patient care, and whose patient population comprises at least 25% with a cancer diagnosis. Results: Six staff members (9.2%) completed the pre-intervention survey, of which three (4.6%) met inclusion criteria. The following barriers were identified in the pre-intervention survey: lack of education and training, lack of resources, and waste of time, as well as the stress of a cancer diagnosis and not wanting to detract from the patient/provider bond. Participants in the pre-intervention survey answered 33% of the knowledge-based questions correctly, and none felt confident in their ability to provide tobacco cessation interventions. Six staff members, (9.2%) completed the post-intervention survey, of which three (4.6%) met inclusion criteria. Following the educational intervention, respondents were able to correctly answer 78% of the knowledge-based questions and all respondents felt confident in their ability to provide tobacco cessation interventions. The greatest limitation of this project was the few number of responses, with less than 10% completing the surveys and intervention. Conclusions: An evidence-based educational intervention increased knowledge and improved self-efficacy for delivering brief tobacco cessation interventions among those who participated. Quality improvement projects such as these may increase application of evidence-based practice and use of the 5 A’s for tobacco cessation, resulting in improved outcomes for oncology patients. The results of this project may provide insight into improving tobacco cessation efforts for patients at TAMC.