Operationalizing smoking cessation models of care in oncology settings: a mixed-methods systematic review.

BACKGROUND: Integrating smoking cessation care with cancer management is a pillar of high-quality care. However, implementation remains variable and little is known about how smoking cessation models are effectively operationalized in oncology settings. OBJECTIVE: To describe the characteristics, adaptations, and operationalization of evidence-based smoking cessation models in oncology settings, and identify approaches to the definition, measurement, and evaluation of implementation outcomes. METHODS: This systematic review followed JBI methodology. Five databases were searched to identify reports published between January 2010 and August 2025. Included reports described the implementation of evidence-based smoking cessation care models or process enhancements in hospitals or cancer services delivering care to people with cancer. Data sources were treated as complementary, synthesized separately, and integrated as a narrative summary. RESULTS: Thirty-eight reports were included, identifying 33 implementation strategies and 38 models of care. Models of care included 3As (n = 18), 5As (n = 11), and 4As (n = 1) brief interventions, and specialist care models (n = 8). Nurses were commonly delegated to initiate smoking conversations (10/38) and facilitate referrals (17/38). Implementation strategies varied, however, education and training programs, and technology enhancements were commonly reported. Adaptation was a prominent feature and identified across most implementation strategies (24/33). Reporting and measurement of implementation outcomes was limited and not always aligned to a defined framework. CONCLUSIONS: Brief 3A models, nurse involvement, and opt-out referral pathways are core characteristics of smoking cessation care in oncology settings. Adaptation and tailoring components appear as a common feature of implementation strategies. Further reporting and evaluation of implementation outcomes is warranted.