The attitude of healthcare professionals to smokers is often negative, stigmatising and unproductive, but can be improved if they help patients to address their problems of dependence rather than simply harassing them to quit.
“We need to be pro-smokers, but anti-smoking,” Dr Frank Leone from the University of Pennsylvania told the ATS meeting.
He said healthcare professionals often feel anger, frustration, disapproval and helplessness when trying to address a patent’s smoking, leading to ‘anaemic’ interventions that, in any case, are likely to fall on deaf ears.
“At the same time, smokers feel exhausted by repeated their failure, and oppressed by an unsympathetic health system,” he said.
An influential 2007 Cochrane review emphasised the need to develop a systematic approach rather than usual ad hoc care. This involved post-hospital follow-up of any smoking cessation initiatives, and the combination of medication with behavioural interventions.
“This takes work, but the more sophisticated we are, the better the outcomes,” Dr Leone said.
He challenged two common assumptions about smoking interventions. “First, the assumption that we cannot do anything useful until patients are ‘ready to quit’ is not valid, but it has permeated all of healthcare.
“Second, smoking cessation is assumed to be just a discharge-day activity, when instead it should be integrated with treatment throughout the hospital stay.
It is essential to change the perspective from ‘quitting’ to ‘helping’, he said.
“By being pro-smoker, we can recognise that we are trying to help a person with a dependence disorder.
We need to validate their concerns in a non-judgmental way, re-frame their goals to identify some achievable intermediate steps, and formally add tobacco dependence to their problem list.”
Establishing tobacco dependence consultation services within hospitals is an effective way to change the healthcare professionals’ attitudes, encourage other clinicians to be more effective in dealing with smokers, and improve outcomes, Dr Leone said.