Smoking Cessation: An Oncology Clinical Nurse Specialist-Led Program

How can hospitals change practice to better implement smoking cessation interventions? A systematic review

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.

Efeitos de uma intervenção educativa com profissionais de enfermagem sobre abordagens ao paciente tabagista: estudo quase-experimental

RESUMO Objetivo: avaliar os efeitos de uma intervenção educativa sobre cessação do tabagismo direcionada à equipe de enfermagem. Método: estudo quase-experimental com 37 profissionais de enfermagem de um hospital brasileiro de maio/2019 a dezembro/2020. A intervenção consistiu em capacitar profissionais de enfermagem sobre abordagens aos pacientes tabagistas, dividida em duas etapas, a primeira, online, pré-requisito para a presencial/videoconferência. O efeito da intervenção foi avaliado por meio do pré- e pós-teste preenchido pelos participantes. Também foram analisados registros em prontuários de pacientes fumantes. Para análise, utilizou-se o Teste do Qui-Quadrado de McNemar. Resultados: houve aumento da frequência das ações visando à cessação tabágica após a intervenção. Diferenças significativas foram encontradas em orientações relacionadas à divulgação aos familiares da decisão de parar de fumar e necessidade de apoio, incentivo à abstinência após alta hospitalar e informações sobre estratégias para cessação do tabaco e recaídas. Conclusão: a intervenção educativa se mostrou inovadora e com grande capacidade de difusão do conhecimento. O pós-teste evidenciou efeito positivo na frequência das ações visando à cessação tabágica implementadas pela equipe de enfermagem.

Targeting Nicotine Addiction

Smoking cessation remains a high priority in oncology nursing practice. That priority gained additional visibility in 2014 when the Oncology Nursing Society (ONS) endorsed the tobacco position statement of the International Society of Nurses in Cancer Care, emphasizing the potential for nurses to reduce adult and youth tobacco use.