Improving smoking cessation outcomes in secondary care: Predictors of hospital staff willingness to provide smoking cessation referral

Identifying Best Implementation Practices for Smoking Cessation in Complex Cancer Settings

Background: In response to evidence about the health benefits of smoking cessation at time of cancer diagnosis, Ontario Health (Cancer Care Ontario) (OH-CCO) instructed Regional Cancer Centres (RCC) to implement smoking cessation interventions (SCI). RCCs were given flexibility to implement SCIs according to their context but were required to screen new patients for tobacco status, advise patients about the importance of quitting, and refer patients to cessation supports. The purpose of this evaluation was to identify practices that influenced successful implementation across RCCs. Methods: A realist evaluation approach was employed. Realist evaluations examine how underlying processes of an intervention (mechanisms) in specific settings (contexts) interact to produce results (outcomes). A realist evaluation may thus help to generate an understanding of what may or may not work across contexts. Results: The RCCs with the highest Tobacco Screening Rates used a centralized system. Regarding the process for advising and referring, three RCCs offered robust smoking cessation training, resulting in advice and referral rates between 80% and 100%. Five RCCs surpassed the target for Accepted Referral Rates; acceptance rates for internal referral were highest overall. Conclusion: Findings highlight factors that may influence successful SCI implementation.

The Perception and Intervention of Internship Nursing Students Helping Smokers to Quit: A Cross-Sectional Study in Chongqing, China

Background: Smoking is among the most preventable causes of death globally. Tobacco cessation can lessen the number of potential deaths. The China Tobacco Cessation Guidelines encourage medical staff to perform the 5As (Ask, Advise, Assess, Assist, Arrange) when delivering tobacco dependence treatments to patients. Nursing students will develop to be nurses in the future and they have to finish 9 months of clinical practicum study in the last year at hospitals or care centers. However, the frequency of behaviors used to help smokers quit among Chinese nursing internship students is unclear. This study analyzed the rate of nurse interns' performance of the 5As and which demographic characteristics, perceptions of smoking and knowledge predicted higher performance of the 5As. Methods: The cluster sampling method was used to select 13 teaching hospitals among 29. All nursing intern students were expected to finish the questionnaire about their 5As behaviors to help patients quit smoking. Their 5As performances were scored from one to five with 5 being the best and scores were summed. A multivariate linear mixed-effect model was employed to test the differences between their 5As. Results: Participating in the survey were 1358 interns (62.4% response rate). The average scores were as follows-Ask-3.15, Advise-2.75, Assess-2.67, Assist-2.58 and Arrange-2.42. A total of 56.3% students perceived that medical staff should perform the 5As routinely to help patients quit smoking. On the other hand, 52.1% viewed clinical preceptors as role models of the 5As. School education regarding tobacco control, smoking dependence treatment, self-efficacy and positive intentions were predictors of higher performance of the 5As (p < 0.001). Conclusions: Nursing internship students seldom administered tobacco dependence treatments to patients. It is essential to improve the corresponding education, skills and self-efficacy of the 5As. Meanwhile, clinical preceptors should procure more training in the responsibilities and skills related to tobacco cessation. In this way, clinical preceptors can be role models of the 5As and impart positive influences on interns.

Acupuncture for smoking cessation: A systematic review and meta-analysis of 24 randomized controlled trials

INTRODUCTION

We evaluate the effectiveness and safety of transdermal acupuncture by needles for smoking cessation.

METHODS

A literature search for randomized controlled trials (RCTs) was performed in seven electronic databases from inception to February 2017. Meta-analysis was conducted using Revman 5.3.0 software. We used either a random effects model (REM) or a fixed effects model (FEM) for pooling data according to the result of a heterogeneity test (defined as significant if I²>75%). Trial sequential analysis (TSA) was applied by TSA 0.9.5.10 Beta software

RESULTS

Twenty-four trials involving 3984 participants were included. The methodological quality was generally low. With regard to smoking abstinence, meta-analysis showed acupuncture was more effective compared to no intervention/waiting list for short-term (4 weeks) cessation (1 trial, RR=2.37, 95% 1.41, 3.97) and long-term (longer than 6 months) (2 trials, RR=2.66, 95% CI: 1.50, 4.70). Compared to acupuncture/auricular acupressure alone, acupuncture plus auricular acupressure showed more benefit for short-term cessation (3 trials, RR=1.52, 95% CI: 1.03, 2.25). Acupuncture plus auricular acupressure was more effective compared to sham acupuncture plus sham auricular acupressure for short-term cessation (3 trials, RR=2.50, 95% CI: 1.44, 4.33) and long-term (2 trials, RR=3.61, 95% CI: 1.37, 9.48). Acupuncture in combination with counseling, educational smoking cessation program or moxibustion had more benefit compared to acupuncture for short-term cessation (3 trials, RR=0.75, 95% 0.63, 0.91) and long-term (2 trials, RR=0.77, 95% CI: 0.56, 1.05), and TSA illustrated the cumulative Z-curve of this comparison for long-term across the traditional boundary of 5% significance and monitoring boundaries. No serious adverse events occurred

CONCLUSIONS

Acupuncture combined with counseling, educational smoking cessation program or moxibustion was more effective than acupuncture as monotherapy with regard to long-term smoking cessation. Further, high quality trials are needed to confirm the result.

A bibliometric analysis of clinical study literature of traditional Chinese medicine therapies for smoking cessation

INTRODUCTION

Traditional Chinese medicine (TCM) is commonly used for smoking cessation in China. The aim of this study is to perform a comprehensive literature search to identify clinical studies on TCM therapies for smoking cessation.

METHODS

Publications of randomized controlled trials, controlled clinical studies, cohort studies, case-control studies, case series and case reports, reviews and cross-sectional studies on smoking cessation using TCM therapies were retrieved from seven databases from their inception to February 2017. The following data were extracted and analyzed: study type, year of publication, language, country or region, journals, participants, intervention and comparison, and outcome.

RESULTS

In total, 260 publications on TCM therapies for smoking cessation were identified from 1980 to 2016, including 52 randomized clinical trials, 7 controlled clinical studies, 1 cohort study, 110 case series, 18 case reports, 50 narrative reviews, 17 systematic reviews, and 5 cross-sectional studies. Of these, 68.5% (178) were published in Chinese and the remaining published in English. Mainland China (n=129, 49.6%) was the leading country in this field, followed by USA (n=27, 10.4%) and UK (n=25, 9.6%). A total of 36 645 participants from 40 countries with age ranging from 12 to 86 years were involved in 188 clinical studies (excluding reviews and cross-sectional studies). The most commonly reported therapies were auricular acupressure (25, 13.3%), body acupuncture (14, 7.4%), and body acupuncture plus auricular acupressure (14, 7.4%). Composite outcomes were most frequently reported (110, 58.5%).

CONCLUSIONS

A substantial number of clinical studies have been conducted and published on TCM therapy for smoking cessation, mainly focusing on acupuncture stimulation techniques. The findings suggest that future research should pay more attention to acupuncture for smoking cessation.

What Are the Perceptions, Experiences, and Behaviors of Health Care Providers After Implementation of a Comprehensive Smoke-Free Hospital Policy?

The aim of this study was to explore the perceptions, experiences, and behaviors of health care providers (HCPs) after the implementation of a comprehensive smoke-free policy. This qualitative descriptive study, using semi-structured interviews, was conducted with 28 HCPs working in a Canadian hospital. Four overarching themes emerged from the analysis including (a) greater support for tobacco reduction, (b) enhanced patient care and interactions, (c) improved staff morale, and (d) some barriers still exist. The main findings suggest a comprehensive smoke-free hospital environment can strengthen the tobacco-free workplace culture within a hospital setting among HCPs where support for tobacco reduction is amplified, patient care and interactions regarding tobacco dependence are improved, and staff morale is enhanced. While there are still some challenging barriers as well as opportunities for improvements, the implementation of a comprehensive smoke-free policy heightened the call-to-action among HCPs to take a more active role in tobacco reduction.

Communication of alcohol and smoking lifestyle advice to the gastroenterological patient

Effective communication between healthcare staff and patients is central to development of the patient-professional relationship. Many barriers influence this communication, often resulting in patients' lack of understanding and retention of information, particularly affecting advice regarding lifestyle habits, such as alcohol consumption and smoking. Alcohol and smoking misuse are potentially modifiable risk factors known to adversely affect a variety of gastroenterological conditions and improvements in communication with patients regarding this is an important management component. This review discusses the clinical impact of these factors and how healthcare professionals can improve communication. We discuss how enhancing verbal communication skills through medical training leads to greater outcomes in patient satisfaction and adherence to treatment and advice. In addition, with the rapid digitalisation of society, platforms such as social media and smartphone applications may be considered as adjuncts to traditional forms of communication.

Attitudes of oncology healthcare practitioners towards smoking cessation: A systematic review of the facilitators, barriers and recommendations for delivery of advice and support to cancer patients

OBJECTIVES

A systematic review of the literature was conducted. The review was conducted using a search of the literature for all years up to October 2016. Statements that identified facilitators, barriers or recommendations surrounding smoking cessation delivery were extracted and analogous statements aggregated to enable thematic analysis. After searching multiple databases and the application of exclusion and inclusion criteria, a total of 19 acceptable studies were identified.

KEY FINDINGS

Delivery of cessation by oncology professionals was impacted by their own knowledge and views, their perception of the benefits to patient health and by the workplace procedures within their institution.

CONCLUSION

Oncology practitioners worldwide face similar issues in delivering smoking cessation advice. By improving training programs that address the attitudes and beliefs which facilitate or block delivery of smoking cessation and by implementing systemic changes within cancer centres, delivery of smoking cessation should be enabled.