The detrimental impact of smoking tobacco can be mitigated when people diagnosed with cancer quit smoking. Assessment of patient smoking status and referral to smoking cessation services are not consistently implemented within cancer services. This study aimed to adapt, implement and evaluate a Queensland Health smoking cessation clinical pathway (the ‘checklist’) into NSW oncology services.
A mixed-method study design was employed using surveys and semi-structured interviews with health professionals from three hospital services. The checklist adaptation process involved smoking cessation training, mapping the clinical pathway and identifying clinical champions. Two services implemented the checklist without adaptations, while the third site incorporated the checklist within their existing medical record assessment.
1446 checklists were completed with about 10% of patients identified as smoking tobacco. Of the identified smokers, 25% accepted referral to smoking cessation services. Pre-implementation collaboration with health professionals and IT facilitated implementation. Checklist implementation within cancer services was generally accepted by health professionals and readily adopted into clinical practice. Adaptation was driven by clinical champions, including the integration of the checklist within existing workflow. Evaluation was based on survey (n=17) and interview data (n=11) with health professionals, who reported that a sense of responsibility and their capacity to carry out the checklist were the most important factors influencing uptake.
Differences between sites in relation to access to resources, checklist modality (hard-copy or electronic), and whether the checklist was physician or nurse-led has provided insightful lessons for further refinement of the checklist and future implementation in cancer services.
This study in three NSW cancer services suggests that implementing an existing smoking cessation clinical pathway is feasible and acceptable to health professionals. Further research is required to identify how best to adapt the checklist into the existing workflows.