Douglas Arenberg, MD
Tobacco cessation is imperative for patients’ health, especially in the context of lung cancer screening programs. According to Douglas Arenberg, MD, the importance of this matter often falls under oncologists’ radars.
“Oncologists should know that it’s never too late to stop smoking,” says Arenberg, an associate professor in the Department of Internal Medicine at the University of Michigan.
At the University of Michigan, Arenberg and colleagues initiated a formal lung cancer screening study in 2013. The researchers audited selected clinic visits at random to assess adherence to published tobacco cessation guidelines. Those findings then prompted them to initiate a systematic, multi-step program to improve upon tobacco practices, from assessing tobacco use to prescribing pharmacotherapy, and referral to tobacco cessation counselors.
In an interview with OncLive
during the IASLC 17th World Conference on Lung Cancer, held in Vienna, Austria, Arenberg, discusses the preliminary findings of this study, and the critical importance of maintaining quality tobacco cessation practices in healthcare clinics.
OncLive: Please provide an overview of the study you presented here at the meeting.
: This is more of a quality-improvement initiative than it is a research study, which is a bit of a departure from my day-to-day work. It started kind of innocently a few years ago, when I had a research resident that wanted to do a research project. We sat and talked about what she was interested in, and we came up with an idea where she was going to look at what our university health system providers did in terms of the basics of tobacco cessation. We defined what we thought the basics were, which we defined based on something put together by the US Preventive Services Task Force.
They recommend the 5 A’s, which stand for the following: ask every patient about tobacco smoking; advise every smoker to quit; assess the willingness to quit; offer assistance to quit either in terms of motivational interviewing or pharmacotherapy; and then arrange a follow-up. Within the limits of our ability to tell how well we were doing those 5 things in a retrospective review of patient charts, we combined that with a survey of physicians at the University of Michigan. I wouldn’t say it was a well-designed or thorough survey, but it was as good as we could do at the time, simply asking people how well they thought they did, and then comparing that with what we found from reviewing the charts. Not surprisingly, what we found was that we, as physicians, think we do a better job than we actually do.
It was on that background that I came into contact with some people from the Michigan Department of Health, and they asked us to set up a system-wide change in terms of how we approach tobacco cessation. The University of Michigan Health System is distributed over a state that’s 3 times the size of Austria, and we have 150 outpatient centers, 40 clinics, 3 hospitals, and nearly 2 million outpatient visits per year.
It’s a daunting task to try and change all of that in 1 fell swoop. How do you eat an elephant? You take one bite at a time. This quality-improvement project is basically our first or second bite of the elephant, which is to simply start by planting these ideas in the minds of various key leaders in each of these clinical centers that are affiliated with the university.
We provided them with some training, and we took 1 individual from each clinic. As an enticement, we provided them with training through the University of Massachusetts Tobacco Treatment Specialist Training Program that we put on in Ann Arbor. We sent them back to the clinics and said, “Take this expertise, and use it any way you want, but here are the things that were important to us.” We then got monthly reports back on how they did regarding the 5 A’s: ask, advise, assess, assist, arrange.
One of the easiest ways to change behavior is to measure it. Over the last year, we’ve shown people their performance and the performance of other clinics. If they wanted to make changes, we came to their clinics and gave 5 or 10 minute talks at their staff meetings, but the most important thing we did was simply tell them that this was something we felt was important.