Smoking Cessation and the Nurse's Role - An Overview of Systematic Reviews
Published: 10 April 2018
Published: 10 April 2018
It is widely known that smoking is linked to various health issues such as heart disease, cancer and lung disease (Rigotti et al. 2012; Thomas et al. 2017).
Rigotti et al. (2012) convey that ‘smoking also increases the risk associated with hospitalisation for surgery.’
Some methods that can help clients to cease smoking include counselling, medications (i.e. varenicline or bupropion), and nicotine replacement therapy in the form of gum or patches (Stead, Koilpillai, Fanshawe & Lancaster, 2016).
A recent systematic review by Rice, Heath, Livingstone-Banks and Hartmann-Boyce (2017), indicated that there is moderate-quality evidence that nurses can help clients to stop smoking via the provision of advice or support.
Stead et al. (2016) found in their systematic review of over fifty studies that there was high-quality evidence supporting the effectiveness of smoking cessation approaches that consist of both behavioural strategies and medications.
Lancaster and Stead (2017) stated in their systematic review that ‘there is high-quality evidence that individually-delivered smoking cessation counselling can assist smokers to quit’. Likewise, Rigotti et al (2012) found in their systematic review that hospitalised clients were more likely to cease smoking when they received counselling combined with nicotine replacement therapy.
For hospitalised smokers, counselling interventions to cease smoking were more effective when they began during hospitalisation and provided support to the client for a month or more post-discharge (Rigotti et al. 2012).
Specifically for preoperative clients, evidence shows that smoking cessation interventions consisting of behavioural strategies as well as nicotine replacement therapy, can help with short-term cessation and assist in the prevention of postoperative morbidity (Thomsen, Villebro & Moller, 2014).
Evidently, pregnancy is another time that clients may be in particular need of assistance to cease smoking.
In the systematic review by Coleman, Chamberlain, Davey, Cooper and Leonardi-Bee (2015), it was concluded that ‘NRT used in pregnancy for smoking cessation increases smoking cessation rates measured in late pregnancy by approximately 40%.’
Chamberlain et al. (2017) found in their recent systematic review that:
‘psychosocial interventions such as ‘counselling, feedback and financial incentives…appear to reduce the number of women smoking in late pregnancy, however the interventions and the context of the interventions need to be carefully considered.’
So far, it has been apparent that evidence supports the smoking cessation interventions that use the behavioural and pharmacological discussed in this article. However, it can be questioned as to whether any other approaches out of the ‘behavioural’ or ‘pharmacological’ categories are evidence-based ways to cease smoking.
One systematic review (White, Rampes, Liu, Stead & Campbell, 2014) found that there is insufficient evidence and methodological concerns with studies related to the use of acupressure, acupuncture and laser therapies for smoking cessation. Thereby, further high-quality studies on these specific therapies are necessary in the future to evaluate whether these strategies can effectively help clients to stop smoking (White, Rampes, Liu, Stead & Campbell, 2014).
Electrostimulation, however, was identified by this systematic review as being unsuccessful at helping clients to stop smoking (White, Rampes, Liu, Stead & Campbell, 2014).
A concern that clients may face when quitting smoking, is the potential for weight gain. Farley, Hajek, Lycett and Averyard (2012) put forward that this concern may act as a deterrent for clients to cease smoking.
Once clients stop smoking, there is evidence to indicate that weight gain may even trigger recommencement of smoking (Farley et al, 2012).
Overall, it appeared from the systematic review by Farley et al (2012) that more research is needed to establish whether weight gain following the cessation of smoking can be limited by interventions such as: exercise, bupropion, nicotine replacement therapy, fluoxetine, or varenicline.
From this overview of systematic reviews, it is clear that smoking cessation can be difficult due to barriers such as: fear of weight gain; post-cessation weight gain triggering recommencement of smoking; and, insufficient evidence or sub-par quality of evidence to support decisions related to particular interventions for smoking cessation.
It can also be suggested that there are potential barriers to effective smoking cessation such as: staffing, costs of interventions, cost of medications, or cost of behavioural treatments for clients.
Madeline Gilkes, CDE, RN, is a Fellow of the Australasian Society of Lifestyle Medicine. She focused her Master of Healthcare Leadership research project on health coaching for long-term weight loss in obese adults. Madeline has found a passion for preventative nursing. She has transitioned from leadership roles (CNS Gerontology & Education, Clinical Facilitator) in the acute/hospital setting to education management and primary healthcare. Madeline’s vision is to implement lifestyle medicine to prevent and treat chronic conditions. Her research proposal for her PhD involves Lifestyle Medicine for Type 2 Diabetes Mellitus. Madeline is a Credentialled Diabetes Educator (CDE) and primarily works in the academic role of Head of Nursing. Madeline’s philosophy focuses on using humanistic management, adult learning theories/evidence and self-efficacy theories and interventions to promote positive learning environments. In addition to her Master of Healthcare Leadership, Madeline has a Graduate Certificate in Diabetes Education & Management, Graduate Certificate in Adult & Vocational Education, Graduate Certificate of Aged Care Nursing, and a Bachelor of Nursing. She is working towards her PhD. See Educator Profile