1
|
Bailey C, Medeiros PDB, Ellwood DA, Middleton P, Andrews CJ, Flenady VJ. A systematic review of interventions to increase the use of smoking cessation services for women who smoke during pregnancy. Aust N Z J Obstet Gynaecol 2023; 63:737-745. [PMID: 37621216 PMCID: PMC10952730 DOI: 10.1111/ajo.13745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Although many pregnant women accept referrals to stop-smoking support, the uptake of appointments often remains low. AIM The aim was to review the success of interventions to increase the uptake of external stop-smoking appointments following health professional referrals in pregnancy. MATERIALS AND METHODS Embase, PubMed, Cochrane Central Register of Controlled Trials, Scopus and CINAHL were searched in February 2023 for studies with interventions to increase the uptake rates of external stop-smoking appointments among pregnant women who smoke. Eligible studies included randomised, controlled, cluster-randomised, quasi-randomised, before-and-after, interrupted time series, case-control and cohort studies. Cochrane tools assessing for bias and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS Two before-and-after studies were included, including a combined total of 1996 women who smoked during pregnancy. Both studies had a serious risk of bias, and meta-analysis was not possible due to heterogeneity. One study testing carbon monoxide monitors and opt-out referrals showed increased uptake of external stop-smoking appointments, health professional referrals and smoking cessation rates compared to self-identified smoking status and opt-in referrals. Results were limited in the second study, which used carbon monoxide monitors, urinary cotinine levels and self-disclosed methods to identify the smoking status with opt-out referrals. Only post-intervention data were available on the uptake of appointments to external stop-smoking services. The number of health professional referrals increased, but change in smoking cessation rates was less clear. CONCLUSIONS There is insufficient evidence to inform practice regarding strategies to increase the uptake of external stop-smoking appointments by women during pregnancy.
Collapse
Affiliation(s)
- Cheryl Bailey
- Centre of Research Excellence in Stillbirth, Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia
| | - Poliana de Barros Medeiros
- Centre of Research Excellence in Stillbirth, Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia
- Department of Paediatrics and NeonatologySunshine Coast University HospitalSunshine CoastQueenslandAustralia
| | - David A. Ellwood
- Centre of Research Excellence in Stillbirth, Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia
- School of Medicine & DentistryGriffith University and Gold Coast University HospitalGold CoastQueenslandAustralia
| | - Philippa Middleton
- Centre of Research Excellence in Stillbirth, Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia
- South Australian Health and Medical Research Institute (SAHMRI) : Women and Kids and The University of AdelaideAdelaideSouth AustraliaAustralia
| | - Christine J. Andrews
- Centre of Research Excellence in Stillbirth, Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia
| | - Vicki J. Flenady
- Centre of Research Excellence in Stillbirth, Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia
| |
Collapse
|
2
|
Kotti T, Katsampouris E, Ruparel M, McEwen A, Dickson JL, Duffy SW, Waller J, Janes SM, Quaife SL. A randomised controlled trial testing acceptance of practitioner-referral versus self-referral to stop smoking services within the Lung Screen Uptake Trial. Addiction 2023; 118:2007-2013. [PMID: 37331722 PMCID: PMC10952744 DOI: 10.1111/add.16269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 05/04/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND AND AIMS Optimising smoking cessation (SC) referral strategies within lung cancer screening (LCS) could significantly reduce lung cancer mortality. This study aimed to measure acceptance of referral to SC support by either practitioner-referral or self-referral among participants attending a hospital-based lung health check appointment for LCS as part of the Lung Screen Uptake Trial. DESIGN Single-blinded two-arm randomised controlled trial. SETTING England. PARTICIPANTS Six hundred forty-two individuals ages 60 to 75 years, who self-reported currently smoking or had a carbon monoxide reading over 10 ppm during the lung health check appointment. INTERVENTION AND COMPARATOR Participants were randomised (1:1) to receive either a contact information card for self-referral to a local stop smoking service (SSS) (self-referral, n = 360) or a SSS referral made on their behalf by the nurse or trial practitioner (practitioner-referral, n = 329). MEASUREMENTS The primary outcome was acceptance of the practitioner-referral (defined as participants giving permission for their details to be shared with the local SSS) compared with acceptance of the self-referral (defined as participants taking the physical SSS contact information card to refer themselves to the local SSS). FINDINGS Half (49.8%) accepted the practitioner-made referral to a local SSS, whereas most (88.5%) accepted the self-referral. The odds of accepting the practitioner-referral were statistically significantly lower (adjusted odds ratio = 0.10; 95% confidence interval = 0.06-0.17) than the self- referral. In analyses stratified by group, greater quit confidence, quit attempts and Black ethnicity were associated with increased acceptance within the practitioner-referral group. There were no statistically significant interactions between acceptance by referral group and any of the participants' demographic or smoking characteristics. CONCLUSIONS Among participants in hospital-based lung cancer screening in England who self-reported smoking or met a carbon monoxide cut-off, both practitioner-referral and self-referral smoking cessation strategies were highly accepted. Although self-referral was more frequently accepted, prior evidence suggests practitioner-referrals increase quit attempts, suggesting practitioner-referrals should be the first-line strategy within lung cancer screening, with self-referral offered as an alternative.
Collapse
Affiliation(s)
- Theodora Kotti
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUnited Kingdom
| | - Evangelos Katsampouris
- Wolfson Institute of Population Health, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUnited Kingdom
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Division of MedicineUniversity College LondonLondonUnited Kingdom
| | - Andy McEwen
- National Centre for Smoking Cessation and TrainingDorchesterUnited Kingdom
| | - Jennifer L. Dickson
- Lungs for Living Research Centre, UCL Respiratory, Division of MedicineUniversity College LondonLondonUnited Kingdom
| | - Stephen W. Duffy
- Wolfson Institute of Population Health, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUnited Kingdom
| | - Jo Waller
- School of Cancer and Pharmaceutical SciencesKing’s College LondonLondonUnited Kingdom
| | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of MedicineUniversity College LondonLondonUnited Kingdom
| | - Samantha L. Quaife
- Wolfson Institute of Population Health, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUnited Kingdom
| |
Collapse
|
3
|
Ohde JW, Warner DO, Egginton JS, Hagedorn HJ. Stakeholder perceptions of using "opt-out" for tobacco use treatment in a cancer care setting: a qualitative evaluation of patients, providers, and desk staff. Implement Sci Commun 2023; 4:117. [PMID: 37730738 PMCID: PMC10510286 DOI: 10.1186/s43058-023-00493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Continued tobacco use in cancer patients increases the risk of cancer treatment failure and decreases survival. However, currently, most cancer patients do not receive evidence-based tobacco treatment. A recently proposed "opt-out" approach would automatically refer all cancer patients who use tobacco to tobacco treatment, but its acceptability to cancer patients and providers is unknown. We aimed to understand stakeholder beliefs, concerns, and receptivity to using the "opt-out" approach for tobacco treatment referrals in a cancer care setting. METHODS Semi-structured interviews were conducted with oncology patients, providers, and desk staff. The sample size was determined when theoretical saturation was reached. Given the differences among participant roles, separate interview guides were developed. Transcripts were analyzed using standard coding techniques for qualitative data using the Consolidated Framework for Implementation Research (CFIR) codebook. Emergent codes were added to the codebook to account for themes not represented by a CFIR domain. Coded transcripts were then entered into the qualitative analysis software NVivo to generate code reports for CFIR domains and emergent codes for each stakeholder group. Data were presented by stakeholder group and subcategorized by CFIR domains and emergent codes when appropriate. RESULTS A total of 21 providers, 19 patients, and 6 desk staff were interviewed. Overall acceptance of the "opt out" approach was high among all groups. Providers overwhelmingly approved of the approach as it requires little effort from them to operate and saves clinical time. Desk staff supported the opt-out system and believed there are clinical benefits to patients receiving information about tobacco treatment. Many patients expressed support for using an opt-out approach as many smokers need assistance but may not directly ask for it. Patients also thought that providers emphasizing the benefits of stopping tobacco use to cancer treatment and survival would be an important factor motivating them to attend treatment. CONCLUSIONS While providers appreciated that the system required little effort on their part, patients clearly indicated that promotion of tobacco cessation treatment by their provider would be vital to enhance willingness to engage with treatment. Future implementation efforts of opt-out systems will require implementation strategies that promote provider engagement with their patients around smoking cessation while continuing to limit burden on providers.
Collapse
Affiliation(s)
- Joshua W Ohde
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA.
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jason S Egginton
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Hildi J Hagedorn
- Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| |
Collapse
|
4
|
Ugalde A, White V, Rankin NM, Paul C, Segan C, Aranda S, Wong Shee A, Hutchinson AM, Livingston PM. How can hospitals change practice to better implement smoking cessation interventions? A systematic review. CA Cancer J Clin 2022; 72:266-286. [PMID: 34797562 DOI: 10.3322/caac.21709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/27/2021] [Accepted: 10/07/2021] [Indexed: 01/07/2023] Open
Abstract
Smoking cessation reduces the risk of death, improves recovery, and reduces the risk of hospital readmission. Evidence and policy support hospital admission as an ideal time to deliver smoking-cessation interventions. However, this is not well implemented in practice. In this systematic review, the authors summarize the literature on smoking-cessation implementation strategies and evaluate their success to guide the implementation of best-practice smoking interventions into hospital settings. The CINAHL Complete, Embase, MEDLINE Complete, and PsycInfo databases were searched using terms associated with the following topics: smoking cessation, hospitals, and implementation. In total, 14,287 original records were identified and screened, resulting in 63 eligible articles from 56 studies. Data were extracted on the study characteristics, implementation strategies, and implementation outcomes. Implementation outcomes were guided by Proctor and colleagues' framework and included acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. The findings demonstrate that studies predominantly focused on the training of staff to achieve implementation. Brief implementation approaches using a small number of implementation strategies were less successful and poorly sustained compared with well resourced and multicomponent approaches. Although brief implementation approaches may be viewed as advantageous because they are less resource-intensive, their capacity to change practice in a sustained way lacks evidence. Attempts to change clinician behavior or introduce new models of care are challenging in a short time frame, and implementation efforts should be designed for long-term success. There is a need to embrace strategic, well planned implementation approaches to embed smoking-cessation interventions into hospitals and to reap and sustain the benefits for people who smoke.
Collapse
Affiliation(s)
- Anna Ugalde
- School of Nursing and Midwifery, Center for Quality and Patient Safety Research and Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Victoria White
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Nicole M Rankin
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Catherine Segan
- Cancer Council Victoria, Melbourne, Victoria, Australia
- Center for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sanchia Aranda
- Department of Nursing, University of Melbourne, Parkville, Victoria, Australia
| | - Anna Wong Shee
- Ballarat Health Services, Ballarat, Victoria, Australia
- Department of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Center for Quality and Patient Safety Research and Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Monash Health, Melbourne, Victoria, Australia
| | - Patricia M Livingston
- School of Nursing and Midwifery, Center for Quality and Patient Safety Research and Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
5
|
Thomson R, McDaid L, Emery J, Naughton F, Cooper S, Dyas J, Coleman T. Knowledge and Education as Barriers and Facilitators to Nicotine Replacement Therapy Use for Smoking Cessation in Pregnancy: A Qualitative Study with Health Care Professionals. Int J Environ Res Public Health 2019; 16:E1814. [PMID: 31121850 DOI: 10.3390/ijerph16101814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 01/05/2023]
Abstract
Smoking during pregnancy is a leading cause of negative pregnancy and perinatal outcomes. While UK guidelines recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy, adherence to NRT is generally low and may partially explain why NRT appears less effective in pregnancy compared to non-pregnant smokers. This study aimed to identify and describe factors associated with NRT adherence from a health professional’s perspective. Two focus groups and one expert group were conducted with 26 professionals involved in antenatal stop smoking services and the data were analysed thematically using a template methodology. From our analyses, we extracted two main themes: (i) ‘Barriers to NRT use in pregnancy’ explores the issues of how misinformation and unrealistic expectations could discourage NRT use, while (ii) ‘Facilitators to NRT use in pregnancy’ describes the different information, and modes of delivery, that stop smoking professionals believe will encourage correct and sustained NRT use. Understanding the barriers and facilitators to improve NRT adherence may aid the development of educational interventions to encourage NRT use and improve outcomes for pregnant women wanting to stop smoking.
Collapse
|