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Assessment of Smoking and Tobacco Use in Newly Diagnosed Veterans With Cancer: Just ASK and Beyond Just ASK: Assisting and Referring
BACKGROUND
Tobacco use is a known factor in oncologic outcomes in Veterans. Lung cancer is not only the leading cause of cancer death in the U.S., but it is also more prevalent among Veterans. Tobacco use is underassessed and undertreated in healthcare settings. Newly diagnosed cancer patients seen at the Day-Treatment Center of Edward Hines Jr. VA Hospital were not consistently screened for tobacco use or appropriately referred to the hospital-based Tobacco Cessation Program.
PURPOSE
This quality improvement project was created to use existing resources to increase the percentage of newly diagnosed cancer patients screened for tobacco use based off the CoC Just ASK Quality Improvement Project and Clinical Study.
METHODS/DATA ANALYSIS
Using Plan-Do-Study- Act (PDSA) quality improvement methodology, a multidisciplinary team led by Oncology Nursing, Oncologists, Pharmacy, Social Work and Behavioral Health, to standardize processes to increase the percentage of tobacco use screening. The primary intervention was designating nurse educators to standardize the cancer treatment education process to include an assessment for tobacco by using the Just ASK criteria. The primary study goal was to increase tobacco use screening from 54.8% (Baseline Data) to 85% (Target State Goal).
RESULTS
Baseline number of tobacco screening in 2021 was 54.8%. From 1/1/22-6/30/22, 52.8% were screened using the Just ASK criteria. After the first PDSA cycle, from 7/1/22-12/31/22, tobacco screenings increased to 95.1%. PDSA cycle two revealed a 25% increase in Q1 accepting referrals. 62.5% of positive tobacco users agreed to accept care compared to 25% in PDSA cycle one.
CONCLUSIONS/IMPLICATIONS
The quality study met the primary goal of screening newly diagnosed cancer patients. The success of this project supported the use of existing VA hospital-based program resources such as educational materials, supportive medication, and behavioral counseling. Interventions directed at standardization of clinical workflow processes through nursing education and linkage to resources increased tobacco screening among newly diagnosed Veterans with cancer. Planned PDSA cycle two will spread standardized processes in the Rad/Onc Department and build capacity to offer smoking cessation assistance to newly diagnosed cancer patients who report as a current smoker. Annual VHA clinical reminders will be built in and satisfied by using an EMR tobacco screen template.
BACKGROUND
Tobacco use is a known factor in oncologic outcomes in Veterans. Lung cancer is not only the leading cause of cancer death in the U.S., but it is also more prevalent among Veterans. Tobacco use is underassessed and undertreated in healthcare settings. Newly diagnosed cancer patients seen at the Day-Treatment Center of Edward Hines Jr. VA Hospital were not consistently screened for tobacco use or appropriately referred to the hospital-based Tobacco Cessation Program.
PURPOSE
This quality improvement project was created to use existing resources to increase the percentage of newly diagnosed cancer patients screened for tobacco use based off the CoC Just ASK Quality Improvement Project and Clinical Study.
METHODS/DATA ANALYSIS
Using Plan-Do-Study- Act (PDSA) quality improvement methodology, a multidisciplinary team led by Oncology Nursing, Oncologists, Pharmacy, Social Work and Behavioral Health, to standardize processes to increase the percentage of tobacco use screening. The primary intervention was designating nurse educators to standardize the cancer treatment education process to include an assessment for tobacco by using the Just ASK criteria. The primary study goal was to increase tobacco use screening from 54.8% (Baseline Data) to 85% (Target State Goal).
RESULTS
Baseline number of tobacco screening in 2021 was 54.8%. From 1/1/22-6/30/22, 52.8% were screened using the Just ASK criteria. After the first PDSA cycle, from 7/1/22-12/31/22, tobacco screenings increased to 95.1%. PDSA cycle two revealed a 25% increase in Q1 accepting referrals. 62.5% of positive tobacco users agreed to accept care compared to 25% in PDSA cycle one.
CONCLUSIONS/IMPLICATIONS
The quality study met the primary goal of screening newly diagnosed cancer patients. The success of this project supported the use of existing VA hospital-based program resources such as educational materials, supportive medication, and behavioral counseling. Interventions directed at standardization of clinical workflow processes through nursing education and linkage to resources increased tobacco screening among newly diagnosed Veterans with cancer. Planned PDSA cycle two will spread standardized processes in the Rad/Onc Department and build capacity to offer smoking cessation assistance to newly diagnosed cancer patients who report as a current smoker. Annual VHA clinical reminders will be built in and satisfied by using an EMR tobacco screen template.
BACKGROUND
Tobacco use is a known factor in oncologic outcomes in Veterans. Lung cancer is not only the leading cause of cancer death in the U.S., but it is also more prevalent among Veterans. Tobacco use is underassessed and undertreated in healthcare settings. Newly diagnosed cancer patients seen at the Day-Treatment Center of Edward Hines Jr. VA Hospital were not consistently screened for tobacco use or appropriately referred to the hospital-based Tobacco Cessation Program.
PURPOSE
This quality improvement project was created to use existing resources to increase the percentage of newly diagnosed cancer patients screened for tobacco use based off the CoC Just ASK Quality Improvement Project and Clinical Study.
METHODS/DATA ANALYSIS
Using Plan-Do-Study- Act (PDSA) quality improvement methodology, a multidisciplinary team led by Oncology Nursing, Oncologists, Pharmacy, Social Work and Behavioral Health, to standardize processes to increase the percentage of tobacco use screening. The primary intervention was designating nurse educators to standardize the cancer treatment education process to include an assessment for tobacco by using the Just ASK criteria. The primary study goal was to increase tobacco use screening from 54.8% (Baseline Data) to 85% (Target State Goal).
RESULTS
Baseline number of tobacco screening in 2021 was 54.8%. From 1/1/22-6/30/22, 52.8% were screened using the Just ASK criteria. After the first PDSA cycle, from 7/1/22-12/31/22, tobacco screenings increased to 95.1%. PDSA cycle two revealed a 25% increase in Q1 accepting referrals. 62.5% of positive tobacco users agreed to accept care compared to 25% in PDSA cycle one.
CONCLUSIONS/IMPLICATIONS
The quality study met the primary goal of screening newly diagnosed cancer patients. The success of this project supported the use of existing VA hospital-based program resources such as educational materials, supportive medication, and behavioral counseling. Interventions directed at standardization of clinical workflow processes through nursing education and linkage to resources increased tobacco screening among newly diagnosed Veterans with cancer. Planned PDSA cycle two will spread standardized processes in the Rad/Onc Department and build capacity to offer smoking cessation assistance to newly diagnosed cancer patients who report as a current smoker. Annual VHA clinical reminders will be built in and satisfied by using an EMR tobacco screen template.
Post Pandemic Return to Colorectal Cancer Screening
Purpose/Background
Colorectal cancer (CRC) screening was significantly curtailed due to the COVID-19 pandemic and Hines VA Medical Center in Illinois performed 50% fewer screening colonoscopies in 2020 compared to 2019 (pre-pandemic). This quality study aimed to increase use of fecal immunochemical tests (FIT) as an alternative screening method while in-person screening was limited. The primary goal was to return to pre-pandemic rates of screening (colonoscopy + FIT) and the secondary goal was to increase monthly screenings by 10% to address the backlog of patients not screened early in the pandemic.
Methods/Data Analysis
Using Plan-Do-StudyAct (PDSA) quality improvement methodology, a multidisciplinary team led by Primary Care, Gastroenterology and Laboratory/Pathology services, standardized processes for dissemination and processing of FIT tests. The first PDSA cycle implemented utilization of Colorectal Cancer Screening & Surveillance Clinical Reports (CRCS/S) to identify average-risk patients due or overdue for screening, devised plain language patient instructions for FIT-based testing, and formalized a mechanism for tracking FIT test kits.
Results
Baseline number of CRC screenings in 2019 was 2,808 (750 colonoscopy + 2,058 FIT). After the first PDSA cycle, CRC screenings were recorded during the 12-month period from April 2021 to March 2022. Colonoscopy + FIT increased to 3,558, largely due to an increase in completed FIT tests (362 colonoscopy + 3,196 FIT tests). While the number of screening colonoscopies was 52% lower compared to 2019, the number of patients screened with FIT increased by 55% after the intervention. Colonoscopy + FIT in the 12 month period starting in April of 2021 exceeded that of 2019, supporting the fact that stoolbased FIT testing was a feasible approach to screening average risk patients while in-person screening activities were restricted.
Conclusions
This quality improvement study met the primary goal of returning to pre-pandemic rates of colonoscopy + FIT and the secondary goal of increasing average number of monthly screenings by 10% to address the backlog of patients not screened early in the pandemic. Interventions directed at optimizing the FIT test process were associated with an increase in completed FIT tests. Planned PDSA cycle two will implement a mailed FIT Outreach pilot to reach additional patients for CRC screening.
Purpose/Background
Colorectal cancer (CRC) screening was significantly curtailed due to the COVID-19 pandemic and Hines VA Medical Center in Illinois performed 50% fewer screening colonoscopies in 2020 compared to 2019 (pre-pandemic). This quality study aimed to increase use of fecal immunochemical tests (FIT) as an alternative screening method while in-person screening was limited. The primary goal was to return to pre-pandemic rates of screening (colonoscopy + FIT) and the secondary goal was to increase monthly screenings by 10% to address the backlog of patients not screened early in the pandemic.
Methods/Data Analysis
Using Plan-Do-StudyAct (PDSA) quality improvement methodology, a multidisciplinary team led by Primary Care, Gastroenterology and Laboratory/Pathology services, standardized processes for dissemination and processing of FIT tests. The first PDSA cycle implemented utilization of Colorectal Cancer Screening & Surveillance Clinical Reports (CRCS/S) to identify average-risk patients due or overdue for screening, devised plain language patient instructions for FIT-based testing, and formalized a mechanism for tracking FIT test kits.
Results
Baseline number of CRC screenings in 2019 was 2,808 (750 colonoscopy + 2,058 FIT). After the first PDSA cycle, CRC screenings were recorded during the 12-month period from April 2021 to March 2022. Colonoscopy + FIT increased to 3,558, largely due to an increase in completed FIT tests (362 colonoscopy + 3,196 FIT tests). While the number of screening colonoscopies was 52% lower compared to 2019, the number of patients screened with FIT increased by 55% after the intervention. Colonoscopy + FIT in the 12 month period starting in April of 2021 exceeded that of 2019, supporting the fact that stoolbased FIT testing was a feasible approach to screening average risk patients while in-person screening activities were restricted.
Conclusions
This quality improvement study met the primary goal of returning to pre-pandemic rates of colonoscopy + FIT and the secondary goal of increasing average number of monthly screenings by 10% to address the backlog of patients not screened early in the pandemic. Interventions directed at optimizing the FIT test process were associated with an increase in completed FIT tests. Planned PDSA cycle two will implement a mailed FIT Outreach pilot to reach additional patients for CRC screening.
Purpose/Background
Colorectal cancer (CRC) screening was significantly curtailed due to the COVID-19 pandemic and Hines VA Medical Center in Illinois performed 50% fewer screening colonoscopies in 2020 compared to 2019 (pre-pandemic). This quality study aimed to increase use of fecal immunochemical tests (FIT) as an alternative screening method while in-person screening was limited. The primary goal was to return to pre-pandemic rates of screening (colonoscopy + FIT) and the secondary goal was to increase monthly screenings by 10% to address the backlog of patients not screened early in the pandemic.
Methods/Data Analysis
Using Plan-Do-StudyAct (PDSA) quality improvement methodology, a multidisciplinary team led by Primary Care, Gastroenterology and Laboratory/Pathology services, standardized processes for dissemination and processing of FIT tests. The first PDSA cycle implemented utilization of Colorectal Cancer Screening & Surveillance Clinical Reports (CRCS/S) to identify average-risk patients due or overdue for screening, devised plain language patient instructions for FIT-based testing, and formalized a mechanism for tracking FIT test kits.
Results
Baseline number of CRC screenings in 2019 was 2,808 (750 colonoscopy + 2,058 FIT). After the first PDSA cycle, CRC screenings were recorded during the 12-month period from April 2021 to March 2022. Colonoscopy + FIT increased to 3,558, largely due to an increase in completed FIT tests (362 colonoscopy + 3,196 FIT tests). While the number of screening colonoscopies was 52% lower compared to 2019, the number of patients screened with FIT increased by 55% after the intervention. Colonoscopy + FIT in the 12 month period starting in April of 2021 exceeded that of 2019, supporting the fact that stoolbased FIT testing was a feasible approach to screening average risk patients while in-person screening activities were restricted.
Conclusions
This quality improvement study met the primary goal of returning to pre-pandemic rates of colonoscopy + FIT and the secondary goal of increasing average number of monthly screenings by 10% to address the backlog of patients not screened early in the pandemic. Interventions directed at optimizing the FIT test process were associated with an increase in completed FIT tests. Planned PDSA cycle two will implement a mailed FIT Outreach pilot to reach additional patients for CRC screening.