Implementing a 3As and 'Opt-Out' Tobacco Cessation Framework in an Outpatient Oncology Setting

Tobacco cessation has been recognized as an important goal for all ambulatory cancer centres to provide the best possible treatment outcomes and quality of life. However, cessation interventions are applied inconsistently in this setting, with less than one-half of tobacco users being offered evidence-based interventions. The 'opt-in' approach traditionally used in cessation, which targets patients who feel ready to quit, may limit the number of patients who are able to receive treatment, and evidence suggests that tobacco users quit at the same rate regardless of their perceived readiness. This paper reports the results of implementing a tobacco cessation framework utilizing the 3As and an 'opt-out' approach as a standard of cancer care at a Regional Cancer Centre. A comparison of data from 2017-2018 and 2018-2019 demonstrated an increase in the number of patients screened for tobacco use (76.9% to 90.1%, respectively), and in the number of accepted referrals to quit support (11.5% to 34.7%, respectively). The revised framework was effective at improving referral acceptance rates, despite tobacco use rates remaining stable among the two groups. This demonstrates that employing the 'opt-out' approach is a more effective strategy to connect patients with the smoking cessation supports required to optimize their cancer care.