Launch of an Opt Out Tobacco Cessation Referral Process Across a
Cancer Care Network
Amy Litterini1, David Spaulding2, Tia Robbins3
Automatic referrals for tobacco cessation should be standard of care for cancer survivors
1. MaineHealth Cancer Care Network; 2. MaineHealth Center for Tobacco Independence; 3. MaineHealth Information Technology
2021: Maine Cancer Foundation Grant: Tobacco Prevention & Cessation
2022: ACoS/CoC Just Ask QI Initiative: Network Training
2023: MSKCC Training, Oncology IT Governance Approval of Opt Out
2023: ACoS/CoC Beyond Ask QI Initiative: Data Dashboard
BACKGROUND & METHODS
As the leading cause of preventable disease, disability and death in the US, tobacco use is also a wellestablished cause of up to 13 types of cancer, cancer -related death, and all-cause mortality. In the state of Maine, where lung cancer has the highest incidence and mortality, tobacco use is higher than the national average (Maine: 15.6%; US: 11.6%). Within the MaineHealth Cancer Care Network in 2024, 10.8% of our survivors are using some form of tobacco or vape at the time of a new cancer diagnosis, but only 25.1% of those individuals were referred for cessation support within 90 days of initial consult.
• In collaboration with the Center for Tobacco Independence, the Epic Build team created a new best practice advisory (BPA) ‘opt out’ automatic referral process which launched in June, 2024. For patients positive for tobacco or vaping at the time of consult for a new cancer diagnosis, the new BPA fired for all staff and providers during multiple encounter types.
RESULTS & CONCLUSION
• The 90-day pilot was launched at seven sites across the network. Edits to the BPA during the pilot period included: 1) the elimination of the diagnosis of “nicotine dependence” to resolve the encounter; and 2) the elimination of the BPA trigger during phone encounters. Two additional sites were added at the end of the pilot period.
• An opt out approach to tobacco cessation referrals is feasible for a large oncology network. The next step includes the roll out of the process across MaineHealth system -wide for all sites and settings.
2024: Epic Build Team creates BPA + BPA Network Launch
Sept. 2024: Seven sites complete 90-day BPA pilot
ACKNOWLEDGEMENTS
Thanks to the Maine Cancer Foundation for the initial grant funding, and Memorial Sloan Kettering for the intensive training. Special thanks to Lauren Couture and Brett Cropp of Oncology Informatics, Martha Seabury of the Center for Tobacco Independence, and May Robb and Kelly Moss of the Epic Build Team.
