Tobacco cessation after cancer diagnosis leads to better patient outcomes. However, tobacco treatment services are frequently unavailable in cancer care settings, and multilevel implementation challenges can impede uptake of new programs. The National Cancer Institute (NCI) dedicated Cancer Moonshot funding through the Cancer Center Cessation Initiative (C3I) for NCI-Designated Cancer Centers to implement or enhance the implementation of tobacco treatment services. We examined a pragmatic application of the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate tobacco treatment programs implemented within Cancer Centers funded through C3I. Using three C3I-funded Centers as examples, we describe how each RE-AIM construct was operationalized to evaluate the implementation of a wide range of cessation services (e.g., tobacco use screening, counseling, Quitline referral, pharmacotherapy) in this heterogeneous group of cancer care settings. We discuss the practical challenges encountered in assessing RE-AIM constructs in real world situations, including using the electronic health record (EHR) to aid in assessment. Reach and effectiveness evaluation required that Centers define the setting(s) where cessation services were implemented (to determine the “denominator”), enumerate the patient population, report current patient tobacco use, patient engagement in tobacco treatment, and 6-month cessation outcomes. To reduce site heterogeneity, increase data accuracy, and reduce burden, reach was frequently captured via standardized EHR enhancements that improved the identification of current smokers and tobacco treatment referrals. Effectiveness was determined by cessation outcomes (30-day point prevalence abstinence at 6-months post-engagement) assessed through a variety of data collection approaches. Adoption was measured by the characteristics and proportion of targeted cancer care settings and clinicians engaged in cessation service delivery. Implementation was assessed by examining the delivery of tobacco screening assessments and intervention components across sites, and provider-level implementation consistency. Maintenance assessments identified whether tobacco treatment services continued in the setting after implementation and documented the sustainability plan and organizational commitment to continued delivery. In sum, this paper demonstrates a pragmatic approach to using RE-AIM as an evaluation framework that yields relevant outcomes on common implementation metrics across widely differing tobacco treatment approaches and settings.
Bibliographical noteFunding Information:
The C3I Coordinating Center was funded by the National Cancer Institute (ICF Contract #17GZSK0031). AR receives funding from NIH/NIDA K12 DA041449, NIH/NCI P30 CA091842- 16S2, and a grant from the Foundation for Barnes-Jewish Hospital. L-SC receives funding from NIH/NCI P30 CA091842- 16S2, NIH/NIDA R01 DA038076. JO received funding from NIH/NCI P30 CA008748-52S3. TB received funding from NIH/NCI P01 CA180945. MW received funding from Case Comprehensive Cancer Center Support Grant (5P30CA043703).
© 2020 D’Angelo, Ramsey, Rolland, Chen, Bernstein, Fucito, Webb Hooper, Adsit, Pauk, Rosenblum, Cinciripini, Joseph, Ostroff, Warren, Fiore and Baker.
- Cancer center
- RE-AIM (Reach Effectiveness Adoption Implementation and Maintenance)
- Smoking Cessation
- Tobacco treatment