IMPLEMENTING SMOKING CESSATION INTERVENTIONS FOR PREOPERATIVE PATIENTS
Creators: name: Etteldorf, James R.
Publisher: name: Zenodo
Year: 2018

description: Background: In the preoperative setting, providers inevitably encounter patients with a smoking history. In the U.S., an estimated 8 to 10 million surgical procedures requiring anesthesia are performed annually on cigarette smokers (Mills et al., 2011). Cigarette smoking has negative health implications for surgical patients to include cardiovascular, pulmonary, and wound healing complications which can result in sequelae such as reintubation, wound dehiscence, and increased length of stay. Smoke cessation prior to any kind of surgery reduces complications, however, information on the effects of smoking and benefits of smoking cessation on surgical outcomes are not regularly provided to patients (Khullar &amp; Maa, 2012; Lauerman, 2008). Additionally, nearly half of surgeons do not regularly provide information or suggest interventions about smoke cessation prior to surgery (Khullar &amp; Maa, 2012). Therefore, the preoperative setting presents an excellent opportunity to provide effective smoking cessation interventions. Method: A toolkit was developed to guide Pre-anesthesia Consultation and Education (PACE) clinic providers when encountering current smokers (CS) or recent smokers (RS). Providers screened patients for smoking history, and when they encountered a current or recent smoker, utilized the algorithm, based on the 5A’s framework (ask, advise, assess, assist and arrange) to guide them through the appropriate steps and interventions. The Transtheoretical Model (TTM) was incorporated into the iv assess component, thereby guiding providers with subsequent interventions (e.g., counselling, educational materials). Smokers in the preparation stage (ready to quit in &lt; 1 month) were further assisted by arranging referral to the Center for Health Promotion (CHP) or California Smoker’s Helpline (CSH). Following the encounter, a data collection sheet was completed and submitted to the author. Descriptive statistics were analyzed for patient demographics, CS: cigarettes, CS: pipe, CS: cigar, CS: years of smoking, CS: ready to quit, CS: counselling, CS: education materials, CS: card/brochure, CS: referred to CHP, CS: referred to CSH, CS: receiving treatment, RS: years of smoking, RS: education materials, RS: support given, cancer diagnosis, and cancer risk linked to smoking. At the end of the data collection period, all providers received and completed a seven-question project evaluation questionnaire. The purpose of the questionnaire was to receive feedback and improve the smoke cessation program. Results: There were a total of 158 current and recent smokers encountered between August 16 and December 14, 2017. Current smokers totaled 134, accounting for 85% of the group. The average age for the group was 53.64 (SD = 13.29), and ranged from 21 to 82. The most frequently used tobacco product observed among the current smokers was cigarettes (n = 128), followed by cigars (n = 7), and pipe (n = 2). Current smokers smoked an average of 29.21 years (SD = 15.51, Min = 1.00, Max = 73.00). Out of the 134 current smokers encountered, the majority of them were ready to quit within 30 days (n = 92, 68.66%). Most of the current smokers received counselling (n = 126, 94.03%) and educational materials (n = 86, 64.18%). Fifty of the current smokers (37.31%) who were ready to quit, accepted referral for smoke cessation counselling/treatment. Only thirteen (9.70%) of the current smokers were already v receiving treatment from another provider. Recent smokers (within 12 months) smoked an average of 29.75 years (SD = 17.13, Min = 1.00, Max = 62.00). The majority of the recent smokers received encouragement or support and educational materials. For most of the current or recent smokers with a diagnosis of cancer or possible cancer, their cancer risk could be increased by, or linked to smoking (n = 33, 71.74%). Implications: Preoperative smoke cessation counselling and intervention is of importance for a variety of reasons. Only a small percentage of smokers presenting to the PACE clinic received care or treatment for smoke cessation. Many patients are unaware that smoking up to the day of surgery can place them at increased risk of surgical complications. Woody et al. (2008) report that patients often have a desire to, and sometimes expect providers to speak with them about their smoking history, and assist them with smoke cessation interventions. Most of the current smokers were ready to quit within 30 days. This program has enabled providers to feel more comfortable discussing the implications of smoking, advising them to quit, providing education materials, and offering referral services to those at the appropriate stage of readiness. For those patients who presented with a diagnosis of cancer or possible cancer, their cancer risk could be increased by, or linked to smoking in most cases. Therefore, from a counselling standpoint, greater emphasis may need to be placed on cancer risk and its link to smoking. This hospital, along with many others are adopting Enhanced Recovery After Surgery protocols which include preoperative smoke cessation as one of the core components. Incorporation of these protocols have resulted in significant improvements to include decreased postoperative complications and length of stay. The preoperative period is an excellent time to “seize the moment” and discuss smoke cessation before vi surgery. Some may require only minimal intervention, while others may require more intensive intervention. In any case, we as providers have a unique opportunity to intervene, in an effort to minimize the impact of smoking in the perioperative setting, and ultimately improve health outcomes.