Smoking Cessation: do you have a role

1
Smoking Cessation do you have a role?

• Susan Kerr
• School of Nursing, Midwifery Community Health
• Glasgow Caledonian University

2
Introductions

• SK worked previously as a practice nurse and
  health visitor. Currently a researcher focusing
  on tobacco-related research. Specific interest
  in older people who smoke and people with mental
  health problems who smoke.
• Workshop attendees current roles
• Community practitioners
• Educators
• Managers/Senior Managers

3
Questions for the Workshop Attendees

• Do you consider that you have a role in relation
  to the delivery of smoking cessation
  interventions (yes/no)?
• If yes, what do you consider your role to be?
• Practitioners
• Educators
• Managers/Senior Managers
• If no, who do you consider has a role in
  delivering smoking cessation interventions?

4
What do the Smoking Cessation Guidelines say
about the Role of Community Practitioners?

• The Smoking Cessation Guidelines for Scotland
  state that one of the main purposes of smoking
  cessation advice delivered by members of the
  Primary Care Team is to motivate an attempt to
  stop smoking.
• Recent evidence suggests that treatment of
  nicotine addiction is best delivered by
  specialist services.

5
What factors might impact on the role of
community practitioners?

• Knowledge
• Attitudes
• Barriers to the delivery of effective smoking
  cessation interventions

6
Some quotes from community-based health
professionals

• P16DN It can be too stressful for some
  people. The stress might be worse for their
  health attitude.
• P7DN Older smokers can be quite touchy. If I
  bring it up they can perceive it as criticism. I
  dont want to damage the relationship that we
  have attitude/practice.
• P37HV If I mention smoking I dont know where
  to take the conversation from there
  knowledge/practice.
• P28GP I think the success rates in the
  elderly are much less than they are in the young
  knowledge/attitude.
• P38GP I have had upteen very good successes
  with older smokers and they have definitely
  reaped health benefits attitude/practice.
• P33PN I think you are probably a group person
  or you are not, so I think there are probably
  quite a lot of patients who I am judging as not
  being group people attitude/practice.

7
Knowledge of Products Services

• Nicotine Replacement therapy how effective is
  it?
• Intensive group/one-to-one support what does it
  involve and how effective is it?
• Pharmacy service what does it involve?
• What do you know about smoking cessation services
  in the area where you are employed?

8
Six months of continuous abstinence following
treatment
9
Models of Behaviour ChangeHealth Belief Model

• The benefits of stopping smoking
• The costs of stopping smoking
• Cues to action
• Levels of self-efficacy

10
The Health Beliefs of Older Smokers

• P07 It hasnt affected my health at all no
  benefit in stopping.
• P03 I think that it would probably benefit
  your health to stop. I get very breathless and
  during the time that I had stopped I noticed a
  difference perceived benefit in stopping.
• P12 I think if I were to stop smoking at my
  age that I would be worse and that my chest would
  be worse too. I think I would be more breathless
  no benefits in stopping/perceived harm.
• P08 I would do anything to give up fags right
  now. First for health, second for wealth
  perceived benefit in stopping.
• P08 The patches are pure nicotine and that is
  going into the veins rather than into your lungs,
  I would worry about that perceived costs in
  trying to stop smoking.
• P11 The practice nurse has said to me, Look
  we have got the patches and we have got the
  chewing gum and all that to help you get off the
  smoking. cue to action.

11
Models of Behaviour ChangeStages of Change
Established Change
Pre-contemplation  
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How can community practitioners enhance their
knowledge skills?

• Smoking cessation training in Scotland
• Brief intervention training (approved/accredited
  by PATH)
• Training in the delivery of intensive
  interventions (approved/accredited by PATH)
• Web address for more information
  www.ashscotland.org.uk/

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Key Points

• Brief opportunistic advice delivered by health
  professionals is highly cost-effective.
• By encouraging clients/patients to attempt to
  stop smoking and by referring them to specialist
  services for support (including the use of
  NRT/Zyban) a practitioner quadruples a
  clients/patients chance of managing to stop
  smoking successfully.
• Community practitioners must have the skills
  required to deliver brief opportunistic
  interventions effectively.

14
References

• NHS Health Scotland/ASH Scotland (2004) Smoking
  Cessation Guidelines for Scotland 2004 update.
  Edinburgh NHS Health Scotland.
• NHS Health Scotland/ASH Scotland (2004)
  Encouraging smokers to stop what you can do.
  Edinburgh NHS Health Scotland.
• PATH/ASH Scotland (2003) Standards for smoking
  cessation training in Scotland. PATH/ASH
  Scotland, Edinburgh. http//www.ashscotland.org.uk
  /