Quitting smoking ahead of cardiothoracic surgery is important to reduce risk, but a new study highlights the many challenges in delivering hospital-based support to patients in the peri-operative period.
The study involved semi-structured interviews with 58 cardiothoracic surgeons, anaesthetists, nurses and physiotherapists working in three public tertiary hospitals and three private hospitals in NSW, who were asked to identify factors that increased their capability and opportunity – or posed barriers – to deliver smoking cessation care to patients scheduled for surgery.
Time constraint was one major barrier identified, with surgeons describing the difficulty in fitting a conversation about stopping smoking into an initial surgical planning interview, according to the study published in Heart, Lung and Circulation.
“The discussion of stopping smoking has to be made but invariably the surgeons don’t have time to do it,” one surgeon reported.
“I have a 45-minute consult and invariably I run over. There’s a lot to talk about in the management of their disease.”
Some doctors believed the task of smoking cessation should fall to someone else: a hospital smoking cessation co-ordinator, or in their absence, a cardiologist, respiratory specialist or GP.
In the study, some anaesthetists and surgeons said they would not prescribe smoking cessation pharmacotherapy for patients because they believed it was unsafe in the peri-operative period. Some appeared to feel they were ill equipped to take on the role.
“There’s patches and gum and electronic cigarettes and cold turkey or whatever,” one surgeon reported.“I’ve got no idea, and I certainly don’t prescribe it. So, I advise them to talk to their GP.”
An apparent lack of interest or support from institutions and workplaces was also identified as a barrier to delivering effective smoking cessation messages, with hospitals’ failure to enforce smoking bans in outdoor areas and an overall shortage of resources such as Quit kits and Quitline referral pads interpreted as “administrative disinterest”.
There was a range of views on the need for formal training – no clinicians felt undertaking personal education was necessary but some described how their hospitals’ lack of interest in professional development and staff training “led to poor awareness and execution of smoking cessation support”.
There were, however, examples of success stories at two hospitals where all members of the multidisciplinary team were delivering the same smoking cessation care co-ordinated by a nurse manager.
Treating patients with empathy and sensitivity, rather than delivering a “belligerent” anti-smoking message, was seen as an important factor for delivering this care in the stressful peri-operative period.
Researcher Nia Luxton and her co-authors from Macquarie University conclude that hospitals should provide ongoing education to clinicians in the provision of smoking cessation advice, support and follow up, and clinicians must develop clarity in their own practices.
“Proactive engagement between clinicians and hospitals can enhance the services provided to cardiothoracic patients in the perioperative period and improve long-term smoking cessation which can prevent disease progression and reduce premature mortality.”