Abstract 3224: Perceptions of facilitators and barriers to smoking cessation among patients and providers in a cancer center: A single institution qualitative exploratory study
Authors: Shenton Luke M. , Perera Udara , Leader Amy , Klassen Ann 
Published: June 2022

Abstract
Cancer patients who continue to smoke during treatment have poorer outcomes for treatment tolerance and mortality; however, cessation after diagnosis is challenging. Our goal was to build a contextual understanding of the needs of patients and clinical staff in a large urban NCI-designated cancer center to inform strategies for creating smoking cessation services for all patients. During one-on-one interviews with patients (n=13) and clinical stakeholders (n=9), we asked about experiences receiving or providing cessation support during treatment, as well as views on patients’ readiness and needs regarding cessation. Transcribed interviews were coded thematically using Green’s predisposing, enabling, and reinforcing influences on cessation service delivery, uptake by patients, and successful cessation, identifying factors as having positive, negative, or mixed impact on each of these three influences. Patient-identified positive predisposing factors to cessation included cancer diagnosis as a wake-up call, health problems, persistent healthcare providers, and cost of cigarettes. Identified negative predisposing factors were excessive pestering by providers and the futility of quitting with an existing diagnosis. Family, friends, intrinsic motivation, and fear played a mixed role. Patients felt developing other ways to deal with stress, cessation programs, and laws and policies could enable them to quit. Negative enablers included cost and time commitment of cessation programs and busy healthcare providers. The role of medication was uncertain. Reinforcement for quit attempts came via societal disapproval of smoking, encouragement, and positive health effects. Negative reinforcers included addiction, anxiety relief via smoking, and triggers from other smokers. Providers identified similar positive predisposing factors as patients, but also felt that providers could be less predisposed to facilitate cessation due to its physical and psychological burden on patients, “therapeutic nihilism” in the medical community, and patients’ limited health literacy, with differing opinions on the role of cessation services in the cancer treatment process. Enabling barriers included lack of a standardized approach, limited time with patients, lack of training in cessation, and perceived barriers for patients in accessing cessation resources. NCI policies, as well as clinicians’ personal experiences with smoking could reinforce the value of cessation efforts but extra work and lack of follow-up when working with cessation programs, and a lack of readiness to quit in many patients served as negative reinforcement. Findings illustrate unmet needs for patients and providers related to cessation and provision of comprehensive cessation care. Results can inform development of improved cessation programs in cancer centers.
Citation Format: Luke M. Shenton, Udara Perera, Amy Leader, Ann Klassen. Perceptions of facilitators and barriers to smoking cessation among patients and providers in a cancer center: A single institution qualitative exploratory study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3224.