Making every contact count: the role of the clinician in smoking cessation during the perioperative period
Editor – We read the paper by Durrand et al about setting up prehabilitation services with interest and would like to highlight our learning and insight from a local smoking cessation service for perioperative patients.1
Smoking is an independent predictor of postoperative complications, and modifications have shown to improve outcomes after surgery.2 The perioperative period can be an auspicious time to address risk-taking behaviours, like smoking, as patients may be more receptive to making positive changes that can impact their health.1 Clinicians can play an important role in patient behavioural change by using strategies like Making Every Contact Count (MECC).1,3
Smoking has been recognised as the main cause of preventable illness and premature mortality in England and is associated with increased perioperative risk and delayed postoperative recovery.4,5 Smoking cessation advice and referral has been shown to be cost effective in helping people quit and is an intervention that lends itself well to MECC.6 Clinicians who are involved in perioperative care can be key personnel in delivering lifestyle advice and referring patients to smoking cessation services.
Yet despite these health risks, nationally there has been a decline in using smoking cessation services and prescriptions for nicotine replacement therapy.4 In our hospital trust, we found that of 122 patients reviewed in preoperative clinic, 21% (26), were identified as smokers. Of those patients, 65% (17/26) were offered a referral to smoking cessation services of which 76% (13/17) declined. With a 59% attendance rate following acceptance of referral, only 8% (2/26) of smokers seen prior to surgery engaged with smoking cessation services. Some of the barriers to successful referral encountered were lack of behavioural modification training among staff and a significant proportion of patients declining referral when given the option of attending.
The National Institute for Health and Care Excellence recommends that patients who smoke and are planning to have surgery should be referred directly to smoking cessation support services. This opt-out model should be part of routine care and staff should be equipped with the skills to deliver this service.6 Hence, we suggest training in MECC and behavioural modification should be incorporated into postgraduate medical and nursing training.
- © Royal College of Physicians 2020. All rights reserved.
References
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- Durrand J
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- Leeds IL
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- Public Health England
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- National Statistics
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- National Institute for Health and Care Excellence
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