I’ll quit smoking when I’m ill – Is a respiratory illness a significant influencing factor in smoking cessation?
Objective:
This research project completes my MSc Nursing studies course at City, University London. The focus of the project was to assess the impact of a respiratory diagnosis on smoking cessation. It is hoped findings will contribute to the body of research regarding smoking cessation with an emphasis on the optimisation of cessation services for smokers with respiratory diseases. Smoking related illnesses are avoidable yet remain a significant cause of morbidity and mortality in the UK, this therefore is a key area of focus in healthcare.
Method:
229 current and ex-smokers with and without a current or previous respiratory diagnosis completed an anonymous online questionnaire. Participants were recruited using convenience and snowballing sampling methods from a respiratory physiology department in a central London hospital, via The British Lung Foundation’s web support forum and through a community lung disease support group. Participants were from a range of socioeconomic status (evaluated by education level and postcode deprivation index score) and predominantly from the United Kingdom with a small number participating from other locations. The questionnaire focused on smoking habit, reasons and motivation to quit and respiratory diagnoses. The following respiratory diagnoses were included in this study: chronic respiratory diagnoses- asthma, chronic obstructive pulmonary disease, emphysema, lung cancer, bronchiectasis and sarcoidosis, acute respiratory diagnoses – pneumonia, influenza, chest infection, pulmonary embolism, pneumothorax, bronchitis, shortness of breath of unknown cause and cough of unknown cause.
Results:
The main reason the majority of ex and current smokers quit or want to quit was to reduce their risk of health problems in general. However, amongst those with a chronic respiratory diagnosis this was the main reason for quitting.
Regardless of the exact diagnosis, when a respiratory diagnosis is made motivation to quit increased from baseline. In acute respiratory diagnoses motivation is highest at the time of diagnosis, then decreases after but still remains higher than before diagnosis. The time of diagnosis can therefore be considered the optimal time for clinicians to address smoking cessation. In chronic respiratory diagnoses motivation to quit further increases after diagnosis therefore there is a longer time frame in which smoking cessation can be encouraged.
Findings will affect practise for clinicians treating smokers in any clinical environment where the benefit of smoking cessation can be approached; from smoking cessation services run in primary care settings, to pre-operative assessments for elective admissions or emergency admissions for conditions such as exacerbations of smoking related diagnoses. It must not be assumed that the GP surgery is the best place for cessation to be addressed. All clinicians should be trained to direct patients to appropriate cessation services at the time of diagnosis, when motivation is at its highest, to optimise successful cessation rates.
Key lessons:
- Clinicians should emphasise the health benefits of smoking cessation and be trained to be able to explain the impact of cessation on specific respiratory diagnoses.
- It is crucial smoking cessation advice is delivered when making a respiratory diagnosis. Clinicians should be aware that motivation to quit is increased at the time of diagnosis and it is therefore an optimal time to encourage cessation.
- Motivation to quit further increases after diagnosis of a chronic lung condition, therefore identifying the time in which cessation should be discussed for optimal results.
- Clinicians must consider the type of respiratory diagnosis they are delivering (chronic or acute) and the impact of the diagnosis on cessation.
- Amongst participants without respiratory diagnoses the most selected main reasons for quitting were due to pregnancy or other health reasons (not respiratory).
Recommendations:
- Smoking cessation training should be provided to clinicians across all healthcare settings to ensure cessation is encouraged and supported at the time of diagnosing a respiratory condition regardless of the clinical setting.
- Smoking cessation training should equip clinicians with an understanding of reasons why smokers with and without respiratory diagnoses want to quit, the changes in motivation to quit smoking when receiving a respiratory diagnosis and the optimal time at which to address cessation.
- Increased awareness amongst clinicians of the smoking cessation services available for their patients is required to ensure appropriate referrals and optimisation of services
Conclusion:
In acute respiratory diagnoses motivation to quit is highest at the time of diagnosis, then decreases after but remains higher than before diagnosis. The time of diagnosis can therefore be considered the optimal time for clinicians to address smoking cessation. In chronic respiratory diagnoses motivation to quit smoking increases at the time of diagnosis and further increases after the diagnosis therefore there is a longer time frame in which smoking cessation must be encouraged by clinicians.
Findings will affect practise for clinicians treating smokers in any clinical environment where the benefit of smoking cessation can be approached. All clinicians should be trained to direct patients to appropriate cessation services at the time of diagnosis, when motivation is at its highest, to optimise successful cessation rates.
In future research information should be collected to enable evaluation of the effect of duration of a respiratory diagnosis and the effect of other diagnoses (non-respiratory) on the decision to quit smoking. Larger sample sizes are required to further evaluate the statistical significance of findings.
Unlike other chronic conditions cost-effective and clinically effective treatments are available to treat tobacco dependency which in turn will reduce smoking related diagnoses. However clinical training is required to ensure effective diagnosis and treatment of tobacco dependence. Dissemination of findings from this study can contribute towards developing integrated, person-centred, and evidence-based services to meet the specific needs of smokers with respiratory diagnoses. This will initially be disseminated through publication of findings in a nursing journal which I feel will be an achievement that will also contribute towards my personal career development.
Conducting this research project has enabled me to not only gain further insight into the impact of a respiratory diagnosis on smoking cessation, but has helped me to appropriately discuss cessation with patients, a conversation that can often be unwelcome.