Maureen O’Brien, CNS, Memorial Sloan Kettering Cancer Center, New York, New York, outlines the tobacco treatment training-oncology (TTT-O), a 2-day workshop that aims to provide oncology nurses with relevant skills for management of tobacco use and treatment of tobacco dependence (TUAT) among patients. 

These results were first presented at the 2025 Oncology Nursing Society (ONS) Congress in Denver, Colorado. 

The Tobacco Treatment Training (TTT-O) Program is an educational program that provides nurses with 16/17 CEU’s.  If interested, please visit www.mskcc.org/tobaccocare. If you have any questions about the program, please contact program coordinator at haquen1@mskcc.org or Maureen O’Brien at obrienm@mskcc.org. If interested in the grant, please contact the primary investigator, Jamie Ostroff, director of the MSK Tobacco Treatment Program at ostroffj@mskcc.org. 

Transcript: 

My name is Maureen O'Brien, I'm a clinical psychiatric, clinical nurse specialist, and a certified tobacco treatment specialist at Memorial Sloan Kettering Cancer Center. I have been asked to answer some questions from a presentation that I just recently provided at ONS [Oncology Nursing Society Congress]. 

What is the background information/rationale for this study?

One of the things you need to understand is that this is an R25 training grant. Our first cohort took place in December 2017, and since then we have been doing 3 trainings per year in person or virtual. We are recruiting multidisciplinary oncology providers and as of January 2025, we have trained 418 participants from 155 cancer care settings in 40 US states, 3 foreign countries, and 1 US territory. 

Although persistent smoking after a cancer diagnosis is linked to adverse effects on mortality, treatment effectiveness, and quality of life, up to 2/3 of our cancer patients who are smoking at the time of the diagnosis will continue to smoke through treatment and afterwards. Most oncology settings have not yet established tobacco use treatment as a standard of care and oncology care providers have identified a lack of staff training and inadequate knowledge of smoking cessation medications as barriers for tobacco use assessment and treatment implementation. Oncology nurses are uniquely positioned to facilitate evidence-based and culturally sensitive conversations about the risk of smoking and the benefits of quitting; however, prior surveys have found that only 30% of nurses assist their patients with making a quit attempt and lack of adequate training is reported as the leading barrier. 

Please describe the method of the intervention.

Our program, we call it TTT-O [tobacco treatment training-oncology]. It consists of marketing and recruitment application, baseline assessment, the TTT-O workshop and evaluation, collaborative visit calls, 6-month assessment, and a 12 -month assessment. 

Starting with marketing, it's marketed through various listservs that cater to health care professionals that work in oncology or tobacco treatment space and it's also through word of mouth. Applicants are reviewed by a faculty assessing for patient eligibility. Once accepted, the participant is sent a baseline assessment asking them to assess their own knowledge, attitude, self-efficacy pertaining to tobacco use and assessment delivery. The training consists of onsite or virtual workshops. The 2-day workshop involves didactic presentations by experts in tobacco use and treatment, case studies, live supervised role plays, and demonstrations with simulated patients. Real-time feedback is provided right after each role play and site level goal setting for tobacco use and assessment quality improvement is discussed in great length on the second day of the training. 

Participants are asked to evaluate each workshop component on day 1 and day 2. Participants then participate in 6 monthly video conference calls referred to as collaboratory calls. During those calls, a quick lecture is provided by our faculty covering topics such as how do you prescribe nicotine replacement therapy to electronic users or the dos and don'ts of billing for tobacco treatment. At the end of the 6-month collaboratory period, participants will complete a 6-month follow-up assessment using the same measures as the baseline assessment and afterwards, then a 12-month post-op workshop. We have abbreviated follow-up assessment focusing on implementation outcomes. 

When this application comes in our team reviews the applicant data for each participant, so we can select them from 1 of our cohorts, which take place 3 times a year. We're looking closely at the participant characteristics which include demographics, geographic location, profession, and the years of experience they have dedicated to oncology. We also look at the cancer care setting they're coming from and the goals they hope to achieve by attending this program, because our goal is that we want to have a very balanced group of participants.

Stepping back just a bit about where our process came from is MSK’s [Memorial Sloan Kettering] communication skills training and research laboratory training program, it's called Comm Skill, is a pioneering communication initiative that trains health care providers in effective communication skills, particularly within the oncology setting, using a blend of didactic lectures and experiential role play exercises. This allows the participant to practice communication skills in a very supportive environment. To achieve this experiential experience, Comm Skill trained actors to simulate the role of a patient who has cancer.

We have taken that further in our program by utilizing the Comm Skill training approach for small group role play exercises by using these trained simulated patient actors who portray a patient with tobacco dependent cancer who continue to smoke during their treatment and has been referred to the tobacco treatment program. For example, the actors are trained to portray an anxious patient who fears giving up their cigarettes, which is their only vice of stress management. They're trained to be a depressed patient who feels shame and embarrassment due to the stigma associated with continued smoking, or they're trained to be a patient who is disengaged and feels indifferent about quitting with feelings of ‘why bother’. 

In this program, we provide 6 major didactic lectures with 3 role play exercises, specifically related to the empathic assessment of tobacco use, the behavioral motivational interviewing, and pharmacotherapy interventions. Each of the role plays has its own vignette. The participants are divided into groups of 4 or 5 learners and is assigned a facilitator from our faculty group who is responsible for the skills, acquisition, and performance feedback process. Each group is assigned their own room to increase comfort and allow for privacy and each room is assigned a trained actor to simulate the tobacco dependent cancer patient in that vignette. The facilitator provides the clinical vignette describing the cancer and tobacco history, the patient's readiness to quit, and the barriers to quitting the patient may be experiencing. Learners are asked to choose from a list of communication counseling goals they would like to work on with the simulated patient. For example, the learner may express assessing smoking status, but become very uncomfortable when the patient pushes back and is not willing to discuss their tobacco history. The learner is encouraged to use open-ended questions and convey interest, concern, and empathy during this encounter. Each learner takes their turn in acting the treatment and provider role and the others in the group observe.

At the end of the 5 minute role play, the learner provides self-evaluation of how they did. Each group member provides feedback, the facilitator shares their observations, and finally, we invite the actor to come back into the room and provide their feedback of how they felt the learner did. Emphasis is placed on providing balanced positive comments and very constructive feedback. Following the same experiential learning format, the second role play simulates a follow-up visit with the vignette that specifically reflects treatment and progress. 

What were the methods and results measured from this study?

For this presentation, we have analyzed data collected from the learner’s application form, their workshop evaluation, and their own knowledge, attitudes, and self-efficacy pertaining to tobacco use and assessment delivery. We collect this data from 3 different time periods: before the workshop, during the workshop, and 6 months post-workshop. All evaluation questions use a 5-point Likert response scale ranging from very confident to not at all confident. 

At the ONS Congress, I specifically presented data from the RN and NP participants. And to date, about 30% of our participants have been RNs and nurse practitioners, 98% of them have been female, 81% have been White/Caucasian, and 90% were Non-Hispanic. Participants came from the following employment settings: 45% from cancer care settings, 25% came from university and medical centers, 22% came from hospital settings, and only 3% came from the community oncology practice, with about 4% coming from other locations like typically private locations, we've had some physicians and medical students in training that have wanted to know this information better. Thirty-three percent of our participants received prior tobacco treatment training, 67% of these participants came from institutions that have a tobacco treatment program on site, and 54% reported having a certified tobacco treatment specialist at their facility.

I showed data on the program's effectiveness in reporting participants' self-efficacy at pre- and post-training time points. Each participant was asked 6 questions and asked to rate themselves on a scale of 1, not being confident, and 5 being very confident. The questions we asked them were: demonstrates empathic listening and patient engagement skills, provides education about the risks of persistent smoking and the benefits of quitting,  assesses cancer patients tobacco use, nicotine dependence, quitting history and readiness to quit smoking, provides evidence-based practical behavioral counseling to a tobacco dependent cancer patient, provides education about cessation, pharmacotherapy, and fosters shared decision-making about medication options, and lastly, demonstrates effective use of motivational counseling with an unmotivated patient. Pre-scores were noted in blue, and post-scores were noted in orange. The post-training self-efficacy scores improved with each question, the biggest improvement we noted for our behavioral motivational counseling and the providing education on pharmacotherapy options. 

We also asked participants to evaluate the course, and the course evaluations of our program workshop was highly favorable as evidenced by a mean rating score for all satisfaction items exceeding 4.45, and that was on a scale of 1 to 5. Participants are overwhelmingly pleased with the didactics, the role play experiences, and the knowledge they're bringing back to their institution, which enhances patient care. 

What is the significance of these results?

The significance is that oncology nurses overwhelmingly welcome the education about tobacco use assessment and treatment in cancer care, and they love the evidence-based experiential training provided by the actors. These are actual quotes for participants, and although dreading the role plays, the comments are overwhelmingly positive, stating the actors made the experience real and the feedback invaluable. The comments that really stand out to me are the ones that state that they can see how their practice moving forward will improve, which can be translated to improved quality care for the patient. 

Are there any next steps for this research?

This is a training grant that includes multidisciplinary groups, but we understand that nurses are in the forefront when working with our patients. Really our next step with this is to increase the number of ONS nurses participating in this program because they really are at the front of working with the patient. 

Is there any advice you would like to offer to over nurses or institutions embarking on this intervention?

We have site level goal settings for tobacco use and assessment quality improvement, and we discuss this at great length on the second day. At the end of the collaboratory calls, the participants are asked to share the progress of their goals or challenges they have encountered so they can support one another. All of this improves patient care. 

I just want to remind people that this is an educational program that provides nurses with 16 or 17 CEUs [Continuing Education Units]. If they're interested, they can either contact me, or if they want to know more about the study, they can certainly contact our prime investigator, Jamie Ostroff, who's the director of the MSK treatment program. 

Source: 

O’Brien M. Addressing gaps in tobacco use assessment and treatment in cancer care: Evidence-based experiential training and professional development for oncology nurses. Presented at the ONS Congress. April 10-13, 2025; Denver, CO.