OBJECTIVES: People who smoke tobacco are in regular contact with the health-care system, yet they rarely receive treatment for this serious health risk. The hospital is an excellent setting for smoking cessation because, faced with illness or the need for surgery, patients who smoke are likely to heed advice to quit. Despite this window of opportunity, few nurses engage in regular smoking cessation counseling. Yet, there are significant benefits of even short-term smoking abstinence, particularly before surgery. We review the evidence of nurses’ effectiveness in promoting smoking cessation and describe the efficacy of an intervention to assist patients to stop smoking before surgery, maintain cessation in the post-operative period, and achieve long-term cessation.
DESIGN: Fostering Abstinence in Smokers of Tobacco (FAST) was a randomized, controlled trial of an intervention, designed for patients admitted to hospital for pre-surgical assessment, based on current understanding of the addiction, cessation, and relapse processes and effective programming for sustained behavior change.
SAMPLE: Subjects were 247 smokers admitted to a large acute, academic, research quaternary care hospital, between November 1999 and May 2001, for elective surgeries provided by 11 services including cardiovascular, urology, and orthopedic surgery.
VARIABLES STUDIED: Smoking status was determined by self-report and confirmed with biochemical measures, including carbon monoxide in expired air and urinary cotinine assays. Covariates included smoking cessation self-efficacy measured with the Smoking Self-Efficacy/Temptation Scale, the Smoking: Stage of Change questionnaire, and psychological distress measured with the Brief Profile of Mood States.
METHODS: The intervention included promotion of a period of abstinence (fast) immediately before surgery to minimize some risks of surgery, enhance post-operative recovery, and increase perceptions of self-efficacy for smoking cessation efforts, and was followed by face-to-face and telephone counseling and nicotine replacement delivered by trained nurses.
FINDINGS: Following surgery, 78.4% of the treatment group had reduced the amount they smoked or abstained completely compared to 48.7% of the control group (OR=3.8; 2.1-6.8 95% CI). Six-months post-op, 56% of the treatment group had stopped smoking compared with 44% of the control group (OR=1.9; 1.0-3.6 95% CI); 93.1% of self-reports were confirmed with urine assays of cotinine. Data collection is not yet complete for a 12-month follow-up assessment although preliminary results are discouraging. Of 44.8% of the participants with data, 26.0% of the treatment group and 27.9% of the control group remained abstinent.
CONCLUSIONS: Our findings demonstrate some benefits of a relatively inexpensive form of cessation support in a population that appears to be amenable to intervention. Further research is required to determine ways to enhance effectiveness, particularly studies of how to reduce relapse once professional support is withdrawn. We must also identify mechanisms that support the incorporation of smoking cessation intervention into standard nursing practice or promote the development of smoking-cessation nursing specialists.
IMPLICATIONS: The updated Clinical Practice Guidelines for treating tobacco use and dependence, published in June 2000, by the US Public Health Service recommend that hospitalized patients be provided smoking cessation treatments. Yet, they grade the evidence available to support the recommendation with a “B,” concluding that some evidence supports the recommendation although the scientific support is not optimal. Further research is required to determine the efficacy of interventions provided by different hospital personnel, including nurses.
Back to Research in Smoking Influences and Cessation
Back to The Advancing Nursing Practice Excellence: State of the Science