Practical advice on smoking cessation: Patients with long-term conditions

Transcription

1 Practical advice on smoking cessation: Patients with long-term conditions Tracy Kirk Primary Care Based Respiratory Nurse Consultant This symposium is organised and funded by Pfizer Prescribing Information for Champix (varenicline tartrate) is available at the Pfizer stand CHA1618 Jan 2014

2 The Power of Habit

3 Smokers in the UK There are about 10 million adults who smoke cigarettes in the UK ASH 2013

4 Smokers in the UK 60% of smokers say they would find it hard to last a whole day without smoking ASH 2013

5 Smokers in the UK About half of all regular smokers will eventually be killed by their addiction ASH 2013

6 Smokers in the UK Every year over 100,000 smokers in the UK die from smoking related causes ASH 2013

7 Smokers in the UK Cigarette smoking is responsible for a third of all respiratory deaths ASH 2013

8 Smokers in the UK Cigarette smoking is responsible for a quarter of all cancer deaths ASH 2013

9 Smokers in the UK Cigarette smoking is responsible for a quarter of all cancer deaths ASH 2013

10 Smokers in the UK Cigarette smoking is responsible for one-seventh of all cardiovascular deaths ASH 2013

11 Why then does smoking cessation appear to be so unsuccessful?

12 Smoking Cessation THE POWER OF NICOTINE

13 The Power of Nicotine Around 70% of smokers try to quit each year but only 2% succeed Burns, D Smoking and Smoking Cessation. In. Lynes, D The Management of COPD in Primary and Secondary Care pp M&K Update Ltd

14 The Power of Nicotine Cigarettes are highly efficient nicotine delivery devices and are as addictive as drugs such as heroin or cocaine Royal College of Physicians Report on Nicotine Addiction

15 The Power of Nicotine The addictive effect of nicotine is linked to its capacity to trigger the release of dopamine - a chemical in the brain that is associated with feelings of pleasure How tobacco smoke causes disease: the biology and behavioural basis for smoking attributable disease; a report for the Surgeon General 2010

16 The Power of Nicotine However, research has suggested that, in the long term, nicotine depresses the ability of the brain to experience pleasure How tobacco smoke causes disease: the biology and behavioural basis for smoking attributable disease; a report for the Surgeon General 2010

17 The Power of Nicotine Thus, smokers need greater amounts of the drug to achieve the same levels of satisfaction How tobacco smoke causes disease: the biology and behavioural basis for smoking attributable disease; a report for the Surgeon General 2010

18 The Power of Nicotine Smoking is therefore a form of self medication Further smoking alleviates the withdrawal symptoms which set in soon after the effects of nicotine wear off How tobacco smoke causes disease: the biology and behavioural basis for smoking attributable disease; a report for the Surgeon General 2010

19 The Power of Nicotine However quitting is defined, relapse is a common feature and one very relevant to the concept of addiction Burns, D Smoking and Smoking Cessation. In. Lynes, D The Management of COPD in Primary and Secondary Care pp M&K Update Ltd

20 The Biology of Addiction

21 Smoking Cessation THE POWER OF DISSONANCE

22 The Power of Dissonance Cognitive dissonance theory is based on 3 fundamental assumptions: 1. Humans are sensitive to inconsistencies between actions and beliefs 2. Recognition of this inconsistency will cause dissonance, and will motivate an individual to resolve the dissonance 3. Dissonance will be resolved in one of 3 basic ways: Change belief Change actions Change perception of action Cooper J Cognitive Dissonance: Fifty years of a classic theory. Sage Publications

23 The Power of Dissonance Change Perception of Action One method of resolution is for us to change the way in which we view or perceive an action In other words, we rationalize our actions We think about the action in a different manner or context so that it no longer appears to be inconsistent with our beliefs Cooper J Cognitive Dissonance: Fifty years of a classic theory. Sage Publications

24 The Power of Dissonance

25 The Power of Dissonance It s too late for me to stop now, what s done is done

26 The Power of Dissonance My dad smoked 40 Woodies a day from being 15 years old and still lived to be 94

27 The Power of Dissonance I never felt right after I stopped smoking so I had to put myself back on them

28 The Power of Dissonance It s only the illegal cigarettes that are harmful

29 The Power of Dissonance I would have given the patches a go but after reading what the side effects were to them I decided not to risk it

30 The Power of Dissonance If cigarettes were as bad as you say they are then the Government would have banned them by now

31 Smoking Cessation THE POWER OF NURSE ADVICE

32 The Power of Nurse Advice Most research, and indeed guidelines, on smoking cessation make the point that the most successful interventions are those combining both psychosocial and pharmacological interventions Burns, D Smoking and Smoking Cessation. In. Lynes, D The Management of COPD in Primary and Secondary Care pp M&K Update Ltd

33 The Power of Nurse Advice The success rate of brief advice (defined as advice lasting two to three minutes) on quitting is about 1 in 40 smokers... Making it one of the most cost effective interventions in medicine! Coleman, T. (2004) Use of simple advice and behavioural support. BMJ, 328,

34 The Power of Nurse Advice All healthcare professionals, regardless of the setting they work in, should be prepared to: Raise the issue of smoking with patients Deliver the message that it is harmful Be prepared to follow up patients who are attempting to quit Burns, D Smoking and Smoking Cessation. In. Lynes, D The Management of COPD in Primary and Secondary Care pp M&K Update Ltd

35 The Power of Nurse Advice There is some evidence that nurses shy away from this topic for various reasons such as: Lack of confidence A perception that they lack the necessary skills Lack of time Burns, D Smoking and Smoking Cessation. In. Lynes, D The Management of COPD in Primary and Secondary Care pp M&K Update Ltd

36 The Power of Nurse Advice There is some evidence that nurses shy away from this topic for various reasons such as: Some assume, incorrectly, that no smoking patient wants to be asked about their smoking Others assume that patients have heard it all before and that they as healthcare professionals are wasting their time Burns, D Smoking and Smoking Cessation. In. Lynes, D The Management of COPD in Primary and Secondary Care pp M&K Update Ltd

37 Smoking Cessation THE POWER OF QOF

38 The Power of QOF Smoking Indicators Points % LTC patients with smoking status recorded in (L12/12) 25 % LTC patients offered support and treatment in (L12/12) 25 % smoking data on all patients over the age of 15 (L24/12) 11 % smoking cessation advice offered or treatment in all current smokers (L24/12) 12

39 The Power of QOF Are you still smoking? Have you thought of stopping? Here are the contact details for the local Stop Smoking Service

40 The Power of QOF COPD Indicators Points % spirometry including reversibility on all diagnosis since 1/4/11 added from 3/12 before to 12/12 after diagnosis 5 % FEV1 recorded in L12/12 7 % record of MRC score and COPD review in last 12/12 to include; exacerbation history, lung function and inhaler technique check 9 % patients with MRC score 3+ in L12/12 with O2 saturation recorded 5

41 The Power of QOF Pre-spirometry safety check to include BP recording, height and weight Perform spirometry at least 10 minutes Post spirometry safety check MRC Score Oxygen saturation CAT Score Exacerbation history? Needs to be given rescue pack steroids and anti-biotics Inhaler technique, adherence to medications? Devise and explain principles of self-management plan Record all of the above on computer

42 Smoking Cessation THE POWER OF HINDSIGHT

43 The Power of Hindsight Practice Nurse COPD education program in South Wales Huge reductions in hospital admissions associated with acute exacerbations of COPD

44 The Power of Hindsight

45 The Power of Hindsight Smoking Cessation in LTC s Project 20 patients: 2 severe depression and referred back to GP 1 of the above has recently reported to his GP that he has now not smoked for over a month 12 stopped smoking 1 quit for 4 weeks then put weight on so started smoking again 2 dropped out due to side effects (vomiting) 1 down to 4 per day 1 down to 6 per day 1 undecided and is having follow up with PN

46 The Power of Hindsight It is unrealistic to expect Practice Nurses to deliver the intensive behavioural support that is fundamental to achieving long term quit rates in person s diagnosed with Long Term Conditions

47 The Power of Hindsight Routine via which smoking cessation is addressed within a LTC disease review needs to change

48 The Power of Hindsight New project in Rhonda Valley: Aim: To increase referrals to Level 3 trained community pharmacists and Stop Smoking Wales service

49 The Power of Hindsight New project in Rhonda Valley: Action: Practice Nurses to be much more proactive in ensuring that patients access and attend smoking cessation services: Smoking cessation advice pack given at end of COPD review Name and contact number of nearest community pharmacist trained to provide smoking cessation services Audit and phone call reminders if patient does not access smoking cessation services