Poster Presentation NSW State Cancer Conference 2023

Tailoring models of care to cancer centres during implementation of the Care to Quit Trial-a smoking cessation trial for patients affected with cancer (#189)

Christine Paul 1 , Alison Young 1 , Melissa McEnallay 1 , Vaibhav Thawal 1 , Shalini Vinod 2 , Fiona Day 3 , Bianca Devitt 4 , Abhijit Pal 5 , Po Yee Yip 6 , Craig Kukard 7
  1. School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
  2. Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, NSW, Australia
  3. Medical Oncology Department, Calvary Mater Newcastle , Newcastle, NSW, Australia
  4. Medical Oncology Department, Eastern Health , Box Hill, Victoria , Australia
  5. Medical Oncology Department , Bankstown-Lidcombe Hospital, Sydney , NSW, Australia
  6. Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney , NSW , Australia
  7. Medical Oncology department, Gosford Private Hospital , Gosford, NSW, Australia

Title: Tailoring models of care to cancer centres during implementation of the Care to Quit Trial-a smoking cessation trial for patients affected with cancer

Background:

Continuing cigarette smoking after a cancer diagnosis is associated with reduced survival and increased severity or likelihood of: treatment toxicity, complications, hospitalisation, medication side effects, recurrence and morbidity.  Care to Quit is a stepped wedge cluster randomised controlled trial designed to implement best practice smoking cessation care through nine cancer centres in NSW and Victoria. The trial aims to optimise the delivery of a smoking cessation intervention in cancer care by tailoring an evidence-based 3A’s model of care to the circumstances and preferences of each participating cancer centre.

Methods:

The implementation intervention was developed based on the Theoretical Domains Framework and in consultation with clinical stakeholders who participated in an APEASE criteria rating exercise of identified strategies. The application of the 3A’s ask-advise-act/help (behavioural support and pharmacotherapy) model of care was then tailored to the needs of the individual cancer centres and different departments through extensive consultation with relevant stakeholders (oncologists, nurses, nurse unit managers, care coordinators, pharmacists, IT professionals, wellness manager etc.) over a period of approximately months.

Results:

A suite of tailored models of care was created across the 6 centres. Tailoring of the 3A’s model for smoking cessation required significant consultation to arrive at a model that was acceptable and reflective of the needs of each individual cancer centre, separate departments and varying staff perspectives. Total consultation time required was high. Some of the preliminary learnings and observations are: a) Centre-specific variations are dependent on the engagement of a range of cancer care disciplines involved in delivering patient care; b) The level of engagement across disciplines influences the intensity of smoking cessation care that can be delivered particularly in relation to pharmacotherapy; and c) There are varying levels of capability and motivation to complete Act/Help across both cancer centres and specialties.        

Conclusion:

Tailoring and implementing evidence-based cessation care in cancer centres is challenging,  time intensive and highly subject to the circumstances of the individual department and cancer centre. The ongoing trial will identify the degree to which the agreed models are sustainable.