Smoking cessation: the role of the nurse

1 Smoking cessation: the role of the nurseCathy LodewijckxClinical nurse Specialist COPDU niversity Hospitals of LeuvenWhat s the problem? Worldwide prevalence: 1,3 billion adult smokers (1) Current world population: 6,4 billion people (2)Evolution in daily smokers (%) in Belgium (1990 2004)38%30%36%33%25%26%24%26%01020304050 1990199520002004% daily smokersMenWomenYearReference: 3% of daily smokers, occasional smokers and non smokers with respect to age in Belgium in 200126%67,5%28%65,9%31%64,4%12%85,5%0204 0608010015-24years25-34years35-54years55 yearsand olderDailySmokersOccasionalsmokersNon smokersReference: 3 Survey in 10 Belgian hospitals Aim: exploring the Smoking behaviour of patients hospitalised on Belgian respiratory wards Sample: n=548 patients 10 Belgian hospitals 3 Walloon hospitals (3 wards) 7 Flemish hospitals (9 wards) : n=316.

2 :n=199; missing: n=33 Mean age: 61,5 years Period: 17 October- 31 October 2005 Reference: 4 Smoking status in 548 patients hospitalised on 12 Belgian respiratory wards31,2%12,6%18,6%21,9%15,5%6,4%46,8%3 3,2%13,6%0%5%10%15%20%25%30%35%40%45%50% non-smokerssmokersex-smokersTotalMaleFem aleReference: 4 Willingness to quit in smokers, and quit-span in ex-smokers, hospitalised on 12 Belgian respiratory wards29%24%5,36%6,13%16,85%4,21%67,44%0% 10%20%30%40%50%60%70%SmokersEx-smokersno t willing to quitwilling to quitno answerquit Smoking for 0-6daysquit Smoking for 7-30daysquit Smoking for 1-6monthsquit Smoking for 6months-1 yearquit Smoking for >1year140 patients(25,6%) need ourhelp47% (n= 55)n=117n=26133% (n=85)Reference: 4 What s the consequence?

3 Tobacco related diseases (5): Cancer, COPD, coronary heart disease, Spontaneous abortion, Worldwide deaths(6): 5 million deaths/year (1/10 adult-deaths) Mortality doubles in the next two decades if current Smoking patterns continueSmoking cessation interventions Behavioural interventions Pharmacotherapy Alternative interventionsReferences: 7 -9 USPHS guideline(United States Public Health Service) Evidence basedguideline: Treating Tobacco Use and Dependence (2000) Major conclusions include: Combination of education, counseling, social support, and pharmacotherapy = most effective Nurses can play a significant role in Smoking cessation Major Recommendation for clinical practice: clinicians should routinely and consistently deliver abrief 5-stepintervention in their daily practice(References: 10-11)Brief 5-step intervention Key points : 5 A s Ask: identify tobacco use status for every patient Advise: urge every tobacco user to quit Asses:is the tobacco user motivatedto quit Assist: for the motivated patient, use counseling and pharmacotherapy to help him/her quit Arrange: schedule follow up contact Not considering quitting or not ready to quit.

4 5 R s Relevance, Risks, Rewards, Roadblocks, Repetition(References: 10-11) Smoking cessation and hospitalisation Hospitalisation (12): Teachable moment: receptivity to Smoking cessation messages by perceived vulnerability Contact with healthcare professionals: can provide a Smoking cessation message or interventionSignificant role for the nurse Largest group of health professionals (13) Strong evidence for efficacy of nursing Smoking cessation interventions (14-17) Cochrane review : strong evidence for efficacy for Smoking cessation interventions for hospitalised patients (12)Nurses perceptions and actions (1) Perceptions: Hospitalisation is an ideal time to quit Smoking Smoking cessation is an important part of the nurse role Actions: Assessing documenting: 50% - 90% Smoking cessation intervention: 30 90% Main reasons for NOT providing Smoking cessation: Patient-related: lack of motivation, privacy, condition, nurse -related : lack of knowledge, skills and confidence.

5 Lack of time(References 18 29)Nurses perceptions and actions (2) Tobacco use among nurses: 7% - 46% (Schulz, 2003) Comparison smokers with former or never smokers: enthusiastic for Smoking cessation intervention confidence in skills and in efficacy of Smoking cessation advice Smoking cessation interventions Knowledge and skills: Nurses perceive lack of knowledge, skills, confidence Formal training in Smoking cessation: 10-20% Effect training: interventions, attitudes, knowledge(References: 18 -22; 24-26; 28-29) CHALLENGES: Integration of tobacco dependence treatment into standard nursing practice Nursing education among Smoking cessation interventions Support for tobacco dependent nurses National outcome studies support (financial, resources) from government and hospital Health Organisation.

6 The World Health Report 2003 - shaping the future. Chapter 6: Neglected global epidemics: three growing 3 October 2005. Website: Internet Usage statistics and Population Stats. World Stats. Retrieved 10 November 2005. Website: en informatiecentrum van de Verbruikersorganisaties en FOD Financi n. Daily smokers, tobacco sails and fiscal earnings on tobacco (1990-2004). Retrieved September 1, 2005. Website: # Vereniging voor Pneumologie-Verpleegkundigen (BVPV). Smoking behaviour in patients hospitalised in Belgian Respiratory Wards. Unpublished m K. The epidemiology of Smoking : Health consequences and benefits of cessation. Drugs 2002; 62(supplement 2): R, Lopez AD. Future worldwide health effects of current smokingpatterns.

7 In: Koop CE, Schwarz MR. (eds). Critical Issues in Global Health, SP, Stoller JK. Smoking cessation. Respiratory Care 2003; 48(12) G. Current approaches to the management of Smoking cessation. Drugs 2002; 62 (supplement. 2): den Bruel A, Cleemput I, Van Linden A, Schoefs D, Ramaekers D, Bonneux L. Efficacy and cost-efficacy of Smoking cessation interventions. Brussel : Federaal Kenniscentrum voor de Gezondheidszorg (KCE); 2004 Juni. KCE Reports vol. 1A. Ref. Retrieved 3 October 2005. Website: Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. A clinical practice guideline for treating tobacco use and dependence. A US Public Health Service Report. JAMA 2000, 283(24), Department of Health and Human Services (2003).

8 Tobacco Cessation You can Quit Smoking Now. Retrieved 10 October 2005. Website: NA, Munafo MR, Murphy MFG, Stead LF. Interventions for Smoking cessation in hospitalised patients (Review). The Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD001837. DOI: Volksgezondheid, Veiligheid van de Voedselketen en of health carers (1995-2004). Retrieved: 10 October 2005. Website: VH, Stead LF. Nursing interventions for Smoking cessation (Review). The Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: DOI: ASH. Nursing and tobacco reduction: A review of the literature. International Journal of Nursing Studies 2003, 40, WA, Suttorp MJ, Sherman SE, Morton SC, Roth EA, Maglione MA, Rhodes SL, Shekelle PG.

9 Smoking -cessation interventions by type of provider: a meta-analysis. American Journal of Preventive Medicine 2004, 26(5), PM, Reilly KR, Miller NH, Debusk RF, Taylor CB. Application of a nurse -managed inpatient Smoking cessation program. Nicotine & Tobacco Research, 4, MC, Hennrikus DJ, Lando HA, Vessey JT. Nurses attitudes concerning the delivery of brief cessation advice to hospitalized smokers. Preventive Medicine 2001; 33: A, Schofield M, Redman S. Australian nurses Smoking behaviour, knowledge and attitude towards providing Smoking cessation care to their patients. Health Promotion International, 14(2), M, Lincoln P, Egeland P, Rosenberg M. Helping hospitalised clients quit Smoking : a study of rural nursing practice and barriers.

10 Australian Journal of Rural Health 2002; 10: MJ, Frazier LM, Wetta-Hall R, Ablah E, Molgaard GA. Kansas office-based nurses evaluation of patient tobacco cessation activities. Journal of Community Health Nursing 2004; 21(2): S, Vogt F, Marteau TM. A short report: Survey of practice nurses attitudes towards giving Smoking cessation advice. Family Practice 2005 (article in press). JM, Chan SSC, Chan SKK, Lam TH., Chi I, Leung GM. Training nurses and social workers in Smoking cessation counseling: a population needs assessment in Hong Kong. Preventive Medicine 2005; 40: AM, Rissel C. Smoking : Rates and attitudes among nursing staff in central Sydney. International journal of nursing practice1999, 5, A, West R. Smoking cessation activities by general practitioners and practice nurses.