Source: DGNews  |  Posted 2 years ago

By Walter Alexander

DUBLIN, Ireland -- May 2, 2009 -- A computer-based, comprehensive, smoking cessation-care strategy for surgical patients is feasible, effective, and inexpensive, according to findings presented at the 2009 Joint Conference of the Society for Research on Nicotine and Tobacco (SRNT) and SRNT-Europe.

The adverse effects of smoking on surgical procedures and outcomes are well known, said John Wiggers, PhD, University of Newcastle, Wallsend, Australia, on April 28. Current guidelines recommend smoking cessation care generally through brief advice.

Despite this, surveys have shown that very few patients receive cessation care at all, with delivery rates reported at 7% for surgeons and 38% for anaesthesiologists. Preoperative nicotine replacement therapy (NRT) was offered by anaesthetists in only 9% of cases.

Prominent among the many barriers to providing smoking cessation care in numerous studies, are lack of organisational support and infrastructure, and lack of time, said Dr. Wiggers.

Reviewing the research, Dr. Wiggers and colleagues identified optimal components: care should be intensive (>20 minutes), multicomponent (counseling, self-help materials, NRT, extended follow-up support), multimodal (face-to-face, telephone, print), and should be delivered by more than 1 healthcare professional.

The resulting strategy directed patients to a computer program assessing smoking status, with carbon monoxide monitoring as the confirmatory measurement criterion. The computer provided cessation counseling with motivational and cognitive behavioural therapy (CBT) components.

Staff members were prompted to provide reinforcement and advice, NRT prior to admission, and postdischarge referral to a telephone Quitline. One tailored telephone counseling session was given to each patient prior to admission, and Quitline support was available for up to 3 months.

Of the 1,004 surgical patients included in the randomised, controlled trial, preoperative smoking cessation was achieved in 78% receiving the intervention and in 65% of controls (P = .04).

After 3 months of follow-up, continued cessation was achieved by 18% in the intervention group and 5% of controls (P = .03). Improved stage of change was reported significantly more in the intervention group among smokers/heavy smokers (42%/43%) than in the control group (25%/22%).

The cost of care delivery considered inexpensive in comparison to other forms of cessation counselling and treatment, and was offset by short-term reductions in complications, length of stay, and readmission rates, Dr. Wiggers said. He also noted that executing the delivery of smoking cessation care placed limited demand on staff and caused little intrusion into clinical care. The program was generally well accepted by staff and participants.

[Presentation title: Provision of Comprehensive Smoking Cessation Care to Surgical Patients: The Case for Routine Clinical Delivery. Abstract PA2-2]