Tobacco Treatment Skills Training and Implementation Strategies to Reduce Preventable US Cancer Outcome Variations

Increasing the treatment of tobacco use is a current U.S. priority, critical to improving outcomes in all phases of cancer care, including prevention, treatment, and survivorship. There are several groups in the US that have exceptionally high rates of smoking and, as a consequence, suffer from high rates of tobacco-related diseases. And yet, many smokers do not have adequate access to effective tobacco cessation treatments. To better assist people highly impacted by cancer, we propose disseminating a program of training, aimed specifically at facilitating routine and consistent tobacco treatment implementation (TTI) within healthcare organizations serving: 1) financially impoverished persons, 2) persons with behavioral health and substance use disorders, 3) rural populations and 4) people living with HIV. Whereas a variety of survey data suggests providers agree with the importance of tobacco treatment in reducing cancer risk, most providers report that they lack the training and implementation support necessary to fully integrate tobacco use treatment interventions into these complex care environments. Therefore, to address this critical practice gap, we will identify clinical change agents from each of the 4 targeted practice environments and engage them in a virtual, multi-modal skill-building TTI curriculum that provides advanced tobacco implementation training and technical assistance. Over the 5-year duration of the project, we will train at least 200 multidisciplinary participants from organizations across the region, and establish a transferable mechanism by which future like-minded organizations may more efficiently increase their tobacco treatment capacity. Our specific aims are to: 1) Deliver the Tobacco Treatment Implementation (TTI) training to 200 multidisciplinary clinicians from the 4 high-impact care settings, 2) Document the practice changes implemented at the trainee’s home institution following curriculum completion, and 3) Assess the sustainability of tobacco use treatment incorporation three months following training. We will evaluate indicators of participant experience, including self-evaluated skill/confidence levels acquired during the TTI training, perceived level of professional responsibility to tobacco treatment, and core content retention and attitude toward treatment effectiveness. By providing this crucial TTI training to providers working within communities at high risk for cancer, important populations of smokers will be provided with effective treatments for tobacco dependence, contributing substantially to a reduction in preventable tobacco-related cancer outcome variations.