Underutilization of Guideline-Concordant Smoking Cessation Treatments in Surgical Patients: Lessons From a Learning Health System

Heiden, Brendan T.; Smock, Nina; Pham, Giang; Chen, Jing-Ling; Craig, Ethan J.; Meyers, Bryan F.; Colditz, Graham A.; Baker, Timothy B.; Bierut, Laura J.; Kozower, Benjamin D.; Chen, Li‐Shiun

doi:10.1097/as9.0000000000000144

Cited by 8 publications

(5 citation statements)

References 9 publications

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“…Our institution, in conjunction with our cancer centre (Siteman Cancer Center, St. Louis, Missouri, USA), instituted the Electronic Health Record-Enabled Evidence-based Smoking Cessation Treatment (ELEVATE) programme as part of the National Cancer Institute Cancer Moonshot Project and the Cancer Center Cessation Initiative (C3I) 17–19. The ELEVATE programme is a hospital-wide, point-of-care, low-burden, EHR-based tool for addressing smoking cessation which has demonstrated sustained efficacy, broad reach and reduced cost compared with other traditional models of tobacco treatment (ie, specialist referral) 18 20 21.…”

Section: Methodsmentioning

confidence: 99%

Assessment of formal tobacco treatment and smoking cessation in dual users of cigarettes and e-cigarettes

Heiden

Baker

Smock

et al. 2022

Thorax

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BackgroundThe utility of electronic cigarettes (‘e-cigarettes’) as a smoking cessation adjunct remains unclear. Similarly, it is unclear if formal tobacco treatment (pharmacotherapy and/or behavioural support) augments smoking cessation in individuals who use both cigarettes and e-cigarettes.MethodsWe performed a longitudinal cohort study of adult outpatients evaluated in our tertiary care medical centre (6/2018–6/2020). E-cigarette use, smoking status and formal tobacco treatment (deterrent pharmacotherapy and/or behavioural support) were assessed in 6-month blocks (eg, cohort 1 (C1)=6/2018–12/2018, C2=1/2019–6/2019 and so on) using our electronic health record. We assessed the relationship between e-cigarette use (either with or without formal tobacco treatment) and point prevalence of smoking cessation at 6 and 12 months.Results111 823 unique patients were included in the study. The prevalence of dual use of cigarettes and e-cigarettes increased significantly over the study period (C1=0.8%; C2=1.1%; C3=1.8%; C4=2.3%; p<0.001). The prevalence of smoking cessation at 12 months was higher among e-cigarette users (20.8%) compared with non-users (16.8%) (risk difference, 4.0% (95% CI 2.5% to 5.5%); adjusted relative risk (aRR) 1.354, 95% CI 1.252 to 1.464, p<0.0001). Further, among dual users of cigarettes and e-cigarettes, the prevalence of smoking cessation at 12 months was higher among individuals who received tobacco treatment (29.1%) compared with individuals who did not receive tobacco treatment (19.6%) (risk difference, 9.5% (95% CI, 4.6% to 14.4%); aRR 1.238, 95% CI 1.071 to 1.432, p=0.004).InterpretationThese results suggest that dual users of cigarettes and e-cigarettes benefit from formal tobacco treatment. Clinicians should consider offering formal tobacco treatment to such patients, though future trials are needed.

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Section: Methodsmentioning

confidence: 99%

Assessment of formal tobacco treatment and smoking cessation in dual users of cigarettes and e-cigarettes

Heiden

Baker

Smock

et al. 2022

Thorax

Self Cite

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“…Surgery is an important point of contact between patients and the health care system and is an excellent opportunity to address the health needs of patients, as they are focused on their health during this time [ 2 , 3 ]. In North America, the prevalence of smoking among surgical patients is between 14% and 27% [ 4 – 6 ] compared to 13% to 14% of the general population [ 7 ]. Smoking is a leading cause of mortality and is associated with the risk of cardiac, infectious, and pulmonary complications, and delayed wound healing after surgery [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to perioperative smoking cessation: A scoping review

Ofori,

Rayner,

Mikhail

et al. 2024

PLoS ONE

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Objective Smoking cessation interventions are underutilized in the surgical setting. We aimed to systematically identify the barriers and facilitators to smoking cessation in the surgical setting. Methods Following the Joanna Briggs Institute (JBI) framework for scoping reviews, we searched 5 databases (MEDLINE, Embase, Cochrane CENTRAL, CINAHL, and PsycINFO) for quantitative or qualitative studies published in English (since 2000) evaluating barriers and facilitators to perioperative smoking cessation interventions. Data were analyzed using thematic analysis and mapped to the theoretical domains framework (TDF). Results From 31 studies, we identified 23 unique barriers and 13 facilitators mapped to 11 of the 14 TDF domains. The barriers were within the domains of knowledge (e.g., inadequate knowledge of smoking cessation interventions) in 23 (74.2%) studies; environmental context and resources (e.g., lack of time to deliver smoking cessation interventions) in 19 (61.3%) studies; beliefs about capabilities (e.g., belief that patients are nervous about surgery/diagnosis) in 14 (45.2%) studies; and social/professional role and identity (e.g., surgeons do not believe it is their role to provide smoking cessation interventions) in 8 (25.8%) studies. Facilitators were mainly within the domains of environmental context and resources (e.g., provision of quit smoking advice as routine surgical care) in 15 (48.4%) studies, reinforcement (e.g., surgery itself as a motivator to kickstart quit attempts) in 8 (25.8%) studies, and skills (e.g., smoking cessation training and awareness of guidelines) in 5 (16.2%) studies. Conclusion The identified barriers and facilitators are actionable targets for future studies aimed at translating evidence informed smoking cessation interventions into practice in perioperative settings. More research is needed to evaluate how targeting these barriers and facilitators will impact smoking outcomes.

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“…Surgery is an important point of contact between patients and the health care system and is an excellent opportunity to address the health needs of patients, as they are focused on their health during this time [2,3]. In North America, the prevalence of smoking among surgical patients is between 14% and 27% [4][5][6] compared to 13% to 14% of the general population [7]. Smoking is a leading cause of mortality and is associated with the risk of cardiac, infectious, and pulmonary complications, and delayed wound healing after surgery [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Underutilization of Guideline-Concordant Smoking Cessation Treatments in Surgical Patients: Lessons From a Learning Health System

Cited by 8 publications

References 9 publications

Assessment of formal tobacco treatment and smoking cessation in dual users of cigarettes and e-cigarettes

Assessment of formal tobacco treatment and smoking cessation in dual users of cigarettes and e-cigarettes

Barriers and facilitators to perioperative smoking cessation: A scoping review

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