Use of a simple smoking cessation checklist can help standardise smoking cessation practices in medical and radiation oncology services, experience at Australian centres has shown.
A NSW study conducted in two metropolitan and one rural hospital evaluated the implementation of a brief smoking cessation intervention.
The two-page Smoking Cessation Clinical Pathway developed by Queensland Health includes the 11-item checklist, a nicotine replacement therapy algorithm, information on dose and use of various NRT products, and links to other resources.
The study, published in the Asia-Pacific Journal of Clinical Oncology, said medical and radiation oncologists, nurses, hospital managers, and allied health practitioners at the participating sites were introduced to the checklist in 1-hour training sessions.
Clinical champions were identified to remind health professionals to use the checklist.
A baseline survey of health professionals found the majority (69%) were already asking about smoking status at first appointments and the majority of them (73%) were providing quitting advice to patients.
However, “Referral to smoking cessation services was reportedly less common: referral to NRT (33%;18/55), or the GP for NRT (31%; 17/55), followed by Quitline services (29%; 16/55), a smoking cessation officer (18%; 10/55) or written materials (18%; 10/55).”
While all three sites were willing to implement the checklist, the largest metropolitan site largely failed to deliver.
The proportion of patients screened with the checklists at each site was 15.9%, 92.0% and 89.5%.
Of those patients who were screened,10% were identified as current smokers and 63% of those were identified as nicotine dependent.
“Oncologists and nurses advised patients of quitting and referral, of which 34 (27%) patients accepted referral, 48 (38%) declined referral and did not want to quit, and 26 (21%) declined referral but wanted to quit.”
“HCP confidence and documentation of assessment and referrals had increased after checklist implementation. This study highlights the strength of clinician-driven implementation and the influence of contextual factors on successful implementation,” it said.
“Embedding the checklist into a paper-based intake form or eMR system was considered exemplary, with both processes providing successful screening.”
Some of the challenges identified were:
- Health professionals not considering smoking cessation part of their role
- The timing of patients’ referral to a smoking cessation service
- The provision of a follow-up patient support service