Prioritizing implementation strategies to enhance smoking cessation delivery in cancer care in Ontario, Canada: a modified Delphi study
Abstract
Background: Smoking cessation is considered the “fourth pillar” of cancer care due to its impact on treatment outcomes, survival, and quality of life. In Ontario, a provincial framework promotes systematic smoking status screening and referrals across Regional Cancer Centers (RCCs), yet integration of evidence-based supports remains inconsistent.
Objective: To identify and prioritize strategies to improve smoking cessation delivery within Ontario RCCs.
Methods: A two-round modified Delphi study engaged health care providers, smoking cessation champions, and patients with lived experience of cancer and tobacco use. In Round 1, 14 panelists rated 13 evidence-informed strategies on a five-point Likert scale; consensus was defined as ≥70% rating of “high” or “very high” likelihood of success. Qualitative feedback informed revisions to six strategies with partial consensus. In Round 2, 12 panelists reassessed the revised strategies.
Results: Four strategies achieved consensus: (i) distributing free cessation medications onsite, (ii) mailing medications to patients, (iii) revising clinical roles to mandate referrals, and (iv) expanding the number of smoking cessation champions. These strategies addressed patient-level barriers (cost, access) and system-level barriers (role clarity, institutional support). Other strategies, including automatic referrals and quality-monitoring systems, had partial or low consensus due to feasibility concerns.
Conclusions: Panelists prioritized strategies that enhance accessibility, affordability, and integration into RCC workflows. Implementing free medication distribution, mandated referrals, and expanded champions can strengthen cessation delivery and normalize cessation as standard cancer care.
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BibTeX
@article{minian2026prioritizing,
title = {{Prioritizing implementation strategies to enhance smoking cessation delivery in cancer care in Ontario, Canada: a modified Delphi study}},
author = {Nadia Minian and Wayne K deRuiter and Reza Zandi and Adina Coroiu and Michael O Chaiton and William K Evans and Scott Veldhuizen and Laurie A Zawertailo and Osnat C Melamed and Lawson Eng and Matthew M George and MaryAnn Bradley and Archie Stewart and Lester Krames and Michelle H Halligan and Caroline B Silverman and Sarwar Hussain and Peter Selby},
journal = {Translational Behavioral Medicine},
year = {2026},
month = oct,
doi = {10.1093/tbm/ibag078},
url = {https://doi.org/10.1093/tbm/ibag078},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Prioritizing implementation strategies to enhance smoking cessation delivery in cancer care in Ontario, Canada: a modified Delphi study
AU - Nadia Minian
AU - Wayne K deRuiter
AU - Reza Zandi
AU - Adina Coroiu
AU - Michael O Chaiton
AU - William K Evans
AU - Scott Veldhuizen
AU - Laurie A Zawertailo
AU - Osnat C Melamed
AU - Lawson Eng
AU - Matthew M George
AU - MaryAnn Bradley
AU - Archie Stewart
AU - Lester Krames
AU - Michelle H Halligan
AU - Caroline B Silverman
AU - Sarwar Hussain
AU - Peter Selby
PY - 2026
DA - 2026/10/29
JO - Translational Behavioral Medicine
DO - 10.1093/tbm/ibag078
UR - https://doi.org/10.1093/tbm/ibag078
AB - Background: Smoking cessation is considered the “fourth pillar” of cancer care due to its impact on treatment outcomes, survival, and quality of life. In Ontario, a provincial framework promotes systematic smoking status screening and referrals across Regional Cancer Centers (RCCs), yet integration of evidence-based supports remains inconsistent. Objective: To identify and prioritize strategies to improve smoking cessation delivery within Ontario RCCs. Methods: A two-round modified Delphi study engaged health care providers, smoking cessation champions, and patients with lived experience of cancer and tobacco use. In Round 1, 14 panelists rated 13 evidence-informed strategies on a five-point Likert scale; consensus was defined as ≥70% rating of “high” or “very high” likelihood of success. Qualitative feedback informed revisions to six strategies with partial consensus. In Round 2, 12 panelists reassessed the revised strategies. Results: Four strategies achieved consensus: (i) distributing free cessation medications onsite, (ii) mailing medications to patients, (iii) revising clinical roles to mandate referrals, and (iv) expanding the number of smoking cessation champions. These strategies addressed patient-level barriers (cost, access) and system-level barriers (role clarity, institutional support). Other strategies, including automatic referrals and quality-monitoring systems, had partial or low consensus due to feasibility concerns. Conclusions: Panelists prioritized strategies that enhance accessibility, affordability, and integration into RCC workflows. Implementing free medication distribution, mandated referrals, and expanded champions can strengthen cessation delivery and normalize cessation as standard cancer care.
SN - 1869-6716
SN - 1613-9860
ER -