Evaluating the utility of a Smoking Cessation Clinical Pathway tool to promote nicotine prescribing and use among inpatients of a tertiary hospital in Brisbane, Australia

A case study of an academic-stakeholder partnership: Evaluation of the '10 000 Lives' smoking cessation health promotion program

ISSUE ADDRESSED

In Australia, smoking prevalence is higher in regional areas than in metropolitan cities; Central Queensland, a central-east district of Queensland, has substantially higher smoking rates than the state average. In November 2017, Central Queensland Public Health Unit (CQPHU) launched the '10 000 Lives' initiative to reduce the smoking prevalence in the region. The initiative partnered with local hospitals and community organisations to increase the uptake of interventions like Quitline in the region. Evaluating a program like '10 000 Lives' is critical for evidence-based health promotion practice. CQPHU partnered with a large metropolitan Australian university to evaluate the '10 000 Lives' through a scheme that provided a stipend for a Doctor of Philosophy (PhD) student.

METHODS

This narrative report describes the experience of evaluating '10 000 Lives' in a collaborative partnership between CQPHU and the public health academia.

RESULTS

A PhD student was recruited to join this collaboration, and both developed a program logic model and completed a process and impact evaluation. This evaluation provided an ideal 'living' case study to embed in the Master of Public Health curriculum and provided the PhD student with teaching experience delivering a demonstration of public health in practice.

CONCLUSION

The collaboration project was highly successful, exemplifying research, learning and practical integration for all partners. SO WHAT?: The partnership demonstrated how universities can work with government health agencies to build practice-based evidence, and importantly give public health students authentic learning opportunities.

Smoking Cessation Interventions and Abstinence Outcomes for People Living in Rural, Regional, and Remote Areas of Three High-Income Countries: A Systematic Review

INTRODUCTION

Tobacco smoking rates in high-income countries are greater in rural, regional, and remote (RRR) areas compared to cities. Yet, there is limited knowledge about interventions targeted to RRR smokers. This review describes the effectiveness of smoking cessation interventions for RRR smokers in supporting smoking abstinence.

AIMS AND METHODS

Seven academic databases were searched (inception-June 2022) for smoking cessation intervention studies to include if they reported on RRR residents of Australia, Canada, or the United States, and short- (<6 months) or long-term (≥6 months) smoking abstinence outcomes. Two researchers assessed study quality, and narratively summarized findings.

RESULTS

Included studies (n = 26) were primarily randomized control (12) or pre-post (7) designs, from the United States (16) or Australia (8). Five systems change interventions were included. Interventions included cessation education or brief advice, and few included nicotine monotherapies, cessation counseling, motivational interviewing, or cognitive behavioral therapy. Interventions had limited short-term effects on RRR smoking abstinence, decreasing markedly beyond 6 months. Short-term abstinence was best supported by contingency, incentive, and online cessation interventions, and long-term abstinence by pharmacotherapy.

CONCLUSIONS

Cessation interventions for RRR smokers should include pharmacotherapy and psychological cessation counseling to establish short-term abstinence, and identify effective means of maintaining abstinence beyond 6 months. Contingency designs are a suitable vehicle for psychological and pharmacotherapy support for RRR people who smoke, and intervention tailoring should be explicitly considered.

IMPLICATIONS

Smoking disproportionately harms RRR residents, who can encounter access barriers to smoking cessation support. High-quality intervention evidence and outcome standardization are still required to support long-term RRR smoking abstinence.

Roles, experiences, and perspectives of the stakeholders of "10,000 Lives" smoking cessation initiative in Central Queensland: findings from an online survey during COVID-19 situation

Issue addressed

The “10,000 Lives” initiative was launched in Central Queensland in November 2017 to reduce daily smoking prevalence to 9.5% by 2030 by promoting available smoking cessation interventions. One of the main strategies was to identify and engage possible stakeholders (local champions for the program) from hospitals and community organisations to increase conversations about smoking cessation and referrals to Quitline. We aimed to understand the roles, experiences and perceptions of stakeholders (possible champions for delivering smoking cessation support) of the “10,000 Lives” initiative in Central Queensland, Australia.

Methods

We conducted a mixed‐method online survey during the COVID‐19 situation (23 June 2020 to 22 August 2020) with a cross‐section of possible stakeholders who were targeted for involvement in “10, 000 Lives” using a structured questionnaire with mostly closed‐ended questions. Questions were asked regarding their roles, experiences and perceptions about smoking cessation and “10,000 Lives”.

Results

Among the 110 respondents, 52 (47.3%) reported having provided smoking cessation support, including referral to Quitline, brief intervention and promoting existing interventions. Among them (n = 52), 31 (59.6%) were from hospitals and health services, 14 (26.9%) were from community services and three (5.8%) were from private medical practices while four of them did not report their setting. Twenty‐five respondents (22.7%) self‐identified as being directly involved with the “10, 000 Lives” initiative, which significantly predicted provision of smoking cessation support (OR 6.0, 95% CI: 2.1‐19.8). However, a substantial proportion (63.5%) of those (n = 52) who reported delivering cessation support did not identify as contributing to “10,000 Lives”.

Conclusions

Stakeholders from hospitals, health services and community services are the main providers of smoking cessation support in Central Queensland. More could be done to support other stakeholders to feel confident about providing cessation support and to feel included in the initiative.

So what?

Engaging with a range of stakeholders is critical for health promotion program success, to further develop the program and to ensure its sustainability. As such, funding needs to be allocated to the activities that enable this process to occur.

Implementation and evaluation of a smoking cessation checklist implemented within Australian cancer services

Introduction

The detrimental impact of smoking tobacco can be mitigated when cancer patients quit smoking. Smoking cessation clinical pathways are inconsistently implemented within Australian cancer services. The aim of this study was to pilot test and evaluate the reach, adoption, and implementation of a smoking cessation checklist within oncology services.

Methods

The checklist was implemented over a 6‐month period in medical and radiation oncology services at two metropolitan and one rural hospital. The RE‐AIM framework guided the evaluation process. Implementation strategies included training, process mapping, and identifying champions. Evaluation measures included a clinical data audit, surveys, and semi‐structured interviews with healthcare professionals (HCPs).

Results

Healthcare professionals (HCPs; N = 63; 41% oncologists, 32% nurses, 27% others) completed 1276 checklists with cancer patients between November 2019 and December 2020. Of the 126 (10%) identified current smokers, 34 (27%) accepted a referral to either Quitline, Nicotine Replacement Therapy, to a general practitioner or dedicated HCP for follow‐up telephone support. There was variation in screening adoption by HCPs across the three hospitals, with 16%, 92% and 89.5% of patients screened respectively. Contextual factors, such as perceived commitment, role identity, and communication processes appeared to influence the outcomes.

Conclusion

A checklist is a simple, effective, and versatile intervention used to standardise smoking cessation practices in medical and radiation oncology services. The checklist supports standardisation of referral practices to smoking cessation services for cancer patients by either oncologist and/or nurses.

How can a coordinated regional smoking cessation initiative be developed and implemented? A programme logic model to evaluate the '10,000 Lives' health promotion initiative in Central Queensland, Australia

OBJECTIVE

This study used a programme logic model to describe the inputs, activities and outputs of the '10,000 Lives' smoking cessation initiative in Central Queensland, Australia.

DESIGN

A programme logic model provided the framework for the process evaluation of '10,000 Lives'. The data were collected through document review, observation and key informant interviews and subsequently analysed after coding and recoding into classified themes, inputs, activities and outputs.

SETTING

The prevalence of smoking is higher in the Central Queensland region of Australia compared with the national and state averages. In 2017, Central Queensland Hospital and Health Services set a target to reduce the percentage of adults who smoke from 16.7% to 9.5% in the Central Queensland region by 2030 as part of their strategic vision ('Destination 2030'). Achieving this target is equivalent to 20,000 fewer smokers in Central Queensland, which should result in 10,000 fewer premature deaths due to smoking-related diseases. To translate this strategic goal into an actionable smoking cessation initiative, the '10,000 Lives' health promotion programme was officially launched on 1 November 2017.

RESULT

The activities of the initiative coordinated by a senior project officer included building clinical and community taskforces, organising summits and workshops, and regular communications to stakeholders. Public communication strategies (e.g., Facebook, radio, community exhibitions of '10,000 Lives' and health-related events) were used to promote available smoking cessation support to the Central Queensland community.

CONCLUSION

The '10,000 Lives' initiative provides an example of a coordinated health promotion programme to increase smoking cessation in a regional area through harnessing existing resources and strategic partnerships (e.g., Quitline). Documenting and describing the process evaluation of the '10,000 Lives' model is important so that it can be replicated in other regional areas with high prevalence of smoking.