Implementing a 3As and ‘Opt-Out’ Tobacco Cessation Framework in an Outpatient Oncology Setting
Round 1
Reviewer 1 Report
See comments in the attached file
Comments for author File: 
Comments.pdf
Author Response
Thank you for reviewing this manuscript. Our responses are in the attachment.
Author Response File: 
Author Response.docx
Reviewer 2 Report
This was a prospective cohort study reporting on changes that occurred in a cancer centre when a 3As and opt-out model was adopted for tobacco cessation in the outpatient ambulatory oncology care setting. The authors calculated the rates of the number of patients who were identified as tobacco users or recent smokers, who were offered a referral to a quit service and those who accepted the quit service. There were two groups for comparison: a control group where the 5As and opt-in model was used in the past and an intervention group where the new model was implemented. This was a well written paper that highlights the simplicity and ease of tobacco screening and support for tobacco cessation can be implemented in the outpatient ambulatory oncology care setting. The following is a list of questions and suggestions for the authors to consider:
- Which providers screened, offered and referred usually? If physicians also did it, it may be worthwhile to specify that they did this. (Trying to appeal to physician readers that this is something easy to do and not just something for allied health/nursing to do)
- How were the patients screened? Was is a questionnaire, verbal questioning, EMR prompt to ask patient?
- Are patient demographics available to show that both the control and intervention group were comparable (i.e. sex, age, type and stage of disease)
- For the quit services, were referrals to PCP and community pharmacies also available in 2015-2016? If not, how can you account for the potential increase in referral rate and acceptance rate was not due to the increase in availability of services?
- I am a bit confused when you said the Smokers’ Helpline referral was not tracked in 2015-2016 (lines 102-103). If this was not tracked, how did you calculate the rate of referral acceptance for the 2015/2016 period.
- I am not sure the 2nd paragraph in the results section is necessary. It is good to know how many patients accepted which of the 3 quit services, but you were unable to compare this to the control group, so it does not really add any value to the analysis.
- For line 150, do you mean referral acceptance rate, instead of the current “referral rate”
Author Response
Thank you for reviewing this manuscript. Our responses are in the attachment.
Author Response File: Author Response.docx
Reviewer 3 Report
Introduction:
Please be more specific with the aim of the paper. Is it to report the impact on moving to a 3A mode on screening and referral rates?
Methods:
Please justify why April 2015 to March 2016 was chosen for the baseline dates? For example why not April 2017 to March 2018? Or the year before?
How was the data collected for analysis? Health care provider? Patient reported? Electronic or paper?
Add a section on data analysis. Frequency statistics and any other analyses performed.
Please add a section on REB approval or waiver and where this was from.
Please provide more details on program logistics both before and after the move to ‘opt out’. Where is screening done? Are there forcing mechanisms with registration etc? This richer information will assist other programs wishing to replicate your success.
Results:
Throughout the results please provide both the actual number and the % (example line 92 only % is given)
Author Response
Thank you for reviewing this manuscript. Our responses are in the attachment.
Author Response File: Author Response.docx
