World No Tobacco Day: Enhancing Tobacco Treatment Training for Oncology Professionals With Maureen O’Brien MS, RN, CNS, PMHCNS-BC, CPAHA

The Need for Enhanced Tobacco Treatment Training

O’Brien emphasized the gap between evidence and practice in tobacco treatment within oncology. Despite clear evidence that continued smoking after a cancer diagnosis worsens mortality, treatment effectiveness, and quality of life, “up to two-thirds of cancer patients who smoke at the time of diagnosis will continue to smoke during their treatment and after their diagnosis.” She noted that most oncology settings have not yet established tobacco use assessment and treatment as a standard of care, citing “a lack of staff training and inadequate knowledge of smoking cessation medications as barriers for tobacco use assessment and treatment implementation.”

The TTT-O Program: Structure and Approach

The TTT-O program, launched in 2017, is a comprehensive, interactive training initiative designed to equip oncology nurses and other clinicians with the skills needed to assess and treat tobacco dependence in cancer patients. As of January 2025, the program has trained 418 participants from 155 cancer care settings across 40 US states, three foreign countries, and one US territory.

O’Brien described the program as “a highly interactive tobacco use assessment and treatment skills workshop and follow-up collaborative learning initiative.” The core components include:

• A two-day in-person or virtual workshop featuring didactic presentations, case examples, and three simulated role-play exercises with trained actors portraying cancer patients
• Six monthly follow-up video calls (“collaborator calls”) for ongoing education, goal review, and support
• Baseline, six-month, and twelve-month assessments to measure knowledge, attitudes, self-efficacy, and implementation outcomes

A unique feature is the use of simulated patients, which O’Brien credits for reinforcing knowledge and building provider confidence: “The use of simulated patients in experiential learning in combination with didactic may improve skill acquisition and provider self-efficacy.”

Experiential Learning: The Role of Simulation

Drawing on the Memorial Sloan Kettering Comskil program, TTT-O incorporates experiential learning through role-play with trained actors. These actors simulate a range of patient scenarios, such as an anxious patient fearful of quitting, a depressed patient experiencing stigma, or a disengaged patient indifferent to cessation. O’Brien explained, “This allows the participant to practice communication skills in a very supportive environment.”

Each small group is assigned a facilitator and a simulated patient. Learners rotate through the provider role, receive real-time feedback from peers, facilitators, and the actor, and are encouraged to use open-ended questions and empathy. “Although most participants dread the role plays, the comments are overwhelmingly positive, stating the actors made the experience real and the feedback invaluable,” O’Brien reported.

Program Outcomes and Participant Feedback

The TTT-O program’s effectiveness is measured through pre- and post-training self-efficacy assessments and course evaluations. O’Brien shared that “post-training self-efficacy scores improved with each question,” with the greatest gains in behavioral motivational counseling and pharmacotherapy education. Course satisfaction was high, with “a mean rating for all satisfaction items exceeding 4.4 on a scale of one to five.”

Participant demographics reveal that 30% were RNs or nurse practitioners, 98% female, and 81% White Caucasian. Most came from cancer care or academic settings, with only 3% from community oncology practices. Notably, only 33% had prior tobacco treatment training, underscoring the need for such programs.

Key participant feedback included recognition of the program’s impact on clinical practice: “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.”

Implications for Oncology Professionals

O’Brien stressed that oncology nurses are “uniquely positioned to facilitate evidence-based and culturally sensitive conversations about the risks of smoking and the benefits of quitting.” However, only 30% of nurses assist patients with quit attempts, with lack of training as the primary barrier. She called for greater participation from nurses, stating, “I do not feel that 30% is representative of our oncology nursing force, and I would definitely like to see that number increase over the next few years.”

Key Takeaways

• Persistent smoking after cancer diagnosis remains a major challenge, with most oncology settings lacking standardized tobacco treatment protocols
• The TTT-O program’s blend of didactic and experiential learning, especially through simulated patient encounters, significantly improves provider confidence and skills
• Participant feedback highlights the value of real-world practice and constructive feedback in changing clinical behavior
• Oncology nurses, pharmacists, and physicians are encouraged to seek out tobacco treatment training to better support their patients and improve outcomes

Call to Action: World No Tobacco Day

In honor of World No Tobacco Day, O’Brien urged oncology professionals to “educate patients about the dangers of tobacco use, provide support for quitting, and advocate for tobacco-free environments.” She concluded, “By actively engaging in these roles, oncology nurses can make a significant impact on reducing tobacco use and improving the health of individuals with and without cancer on World No Tobacco Day and throughout the year.”

For more information about the TTT-O program, O’Brien invites interested professionals to contact her at [email protected].

The Tobacco Treatment Training (TTT-O) Program is an educational program that provides CEU’s. If interested, please go to our website at www.mskcc.org/tobaccocare. If you have any questions about the program, please contact our program coordinator at [email protected] or you can reach me at [email protected]. If people want to know more about the Grant, they can contact the Primary investigator, Jamie Ostroff, director of the MSK Tobacco treatment Program and she can be reached at [email protected].

About Ms. O’Brien

Maureen O’Brien, MSN, RN, PMHCNS-BC, CTTS, is a Clinical Nurse Specialist and Certified Tobacco Treatment Specialist at Memorial Sloan Kettering Cancer Center, where she has dedicated over four decades to oncology nursing. With more than 20 years of experience in tobacco treatment, Maureen is recognized nationally for her leadership in clinician education and serves on the board of the Association for the Treatment of Tobacco Use and Dependence (ATTUD). She is passionate about advancing evidence-based tobacco cessation practices in oncology care.