Smoking cessation treatment by Dutch respiratory nurses: Reported practice, attitudes and perceived effectiveness

https://doi.org/10.1016/j.pec.2007.09.002Get rights and content

Abstract

Objective

To describe Dutch respiratory nurses’ current smoking cessation practices, attitudes and beliefs, and to compare these with a survey from the year 2000, before the national introduction of a protocol for the treatment of nicotine and tobacco addiction (the L-MIS protocol).

Methods

Questionnaire survey among all 413 registered respiratory nurses in the Netherlands in 2006.

Results

The response rate was 62%. Seventy-seven percent of the respondents reported to have “fairly good” or “good” knowledge of all steps of the L-MIS protocol. Seven out of 10 behavioural techniques for smoking cessation from the protocol were used by more than 94% of the respondents. Seventy-four percent of the respiratory nurses recommended the use of either nicotine replacement therapy (70%) or bupropion (44%). Almost two-thirds (65% of 254) perceived lack of patient's motivation as the most important barrier for smoking cessation treatment; a four-fold increase compared to the year 2000.

Conclusion

We conclude that respiratory nurses are compliant with the L-MIS protocol. They offer intensive support and use behavioural techniques for smoking cessation more frequently than evidence-based pharmacological aids for smoking cessation. Perceived lack of patient's motivation forms the most important threat to respiratory nurses’ future smoking cessation activities.

Practice implications

International guidelines acknowledge that respiratory patients have a more urgent need to stop smoking but have more difficulty doing so. They should be offered the most intensive smoking cessation counselling in combination with pharmacotherapy. This kind of counselling may be more feasible for respiratory nurses than for physicians who often lack time. Their efforts could be increased by reimbursing pharmacological aids for smoking cessation and by developing simple tools to systematically assess motivation to quit and psychiatric co-morbidity in smoking patients.

Introduction

According to national and international guidelines [2], [3], nurses can play an important role with regard to smoking cessation treatment. They are the largest group among health care providers and can treat patients for smoking cessation effectively [4]. In the Netherlands, as in a number of other countries, respiratory nurses are a relatively new discipline (starting in the 1990s). They are nurses with additional training in respiratory medicine. Supporting smoking cessation attempts is a vital part of respiratory nurses’ work as most of their clientele are patients with diseases which aetiology and prognosis are closely related to smoking. For example, smoking is the primary cause of chronic obstructive pulmonary disease (COPD), and smoking cessation is the single most effective way to reduce the risk of developing COPD and to affect the outcome in patients at all stages of the disease [5], [6].

There is only little empirical data available on Dutch respiratory nurses’ reported practice, attitudes and beliefs towards smoking and smoking cessation. The only study we could find is a report on a survey that was performed in 2000 by a research and consultancy agency on behalf of the Dutch foundation for a smoke free future (STIVORO) [7]. Since then, a protocol for the treatment of nicotine and tobacco addiction (the so-called “L-MIS”) [1] has been implemented nationally among all respiratory nurses and new evidence has become available on various smoking cessation strategies [8], [9], [10], [11]. The L-MIS protocol basically describes seven steps of smoking cessation treatment during several consultations. These steps are listed in the text box.

We performed a questionnaire survey among all registered respiratory nurses in the Netherlands to assess and describe their current smoking cessation practices, attitudes and beliefs. Furthermore, we wanted to compare the results from the current survey with the STIVORO survey from the year 2000, before the introduction of the L-MIS protocol. By doing these analyses, we wanted to assess the feasibility of respiratory nurses for taking on greater responsibility for smoking cessation treatment, because primary care physicians can only deliver minimal care in this respect.

Steps of the L-MIS protocol [1]

  • Step 1:

    Quick smoking cessation advice by the lung physician.

  • Step 2:

    Smoking characteristics. Ask about the patients’ smoking status, cigarettes smoked per day, and readiness to quit. Nicotine addiction is defined by smoking more than 15 cigarettes per day or smoking the first cigarette within 30 min after waking up in the morning.

  • Step 3:

    Motivation for quitting. Ask readiness for quitting and reasons for smoking and quitting. Discuss health risks of smoking and the pros of quitting.

  • Step 4:

    Barriers of quitting. Discuss barriers of quitting and problems with previous quit attempts. Increase self-efficacy.

  • Step 5:

    Target quit date (TQD). Make arrangements for quitting and planning of a target quit date.

  • Step 6:

    Discuss the use pharmacological aids. The protocol recommends to use NRT particularly in nicotine addicted smokers and bupropion in addicted smokers who had several previous quit attempts.

  • Step 7:

    Follow-up. Evaluation of the quit attempt. Motivate quitters to refrain from smoking and relapsers to start a new quit attempt.

Steps 2–6 occur during the first and second consultation (2 weeks later) with the respiratory nurse. The duration of both consultations is 30–45 min. A telephonic consultation is planned on the TQD. Follow-up consultations are recommended 2 weeks after the TQD and after 3, 6, and 12 months (5–10 min each).

Section snippets

Questionnaire development and content

The questionnaire was developed by the author and the co-authors (a group of two epidemiologists, one lung physician, and two respiratory nurses). The relevance of the different aspects of the questionnaire (content validity) was assessed by reviewing the content of current evidence-based guidelines [2], [3] and earlier surveys among Dutch respiratory nurses [7] and physicians [12]. Furthermore, we asked experts in the field to judge the questionnaire (face validity). The questionnaire included

Response

Two hundred fifty-four of the 413 respiratory nurses filled out and returned the questionnaire (response rate 62%). Another 46 (11%) returned the reply card of the last mailing and stated reasons for not responding. The most frequently mentioned reasons were “I only work with children”, “I do not work as a respiratory nurse any more”, and “I do not have to do with smoking patients in my job”.

Characteristics of the study population

Table 1 shows demographic, smoking and work-related characteristics of the respondents. Two hundred

Discussion

We conducted a questionnaire survey about smoking cessation treatment among all respiratory nurses registered at the Dutch Society of Respiratory Nurses (NVL). We compared our results where possible with the results from a survey conducted on behalf of the Dutch foundation for a smoke free future (STIVORO) in 2000, before the national introduction of a protocol for the treatment of nicotine and tobacco addiction (the so-called “L-MIS” protocol). Compared with the year 2000, respiratory nurses

Acknowledgements

We would like to thank Kitty van der Meer for her help with the administration of the survey.

Competing interests: The authors have no competing interests.

Funding: This study was supported by a grant from Pfizer. The funding source had no involvement in study design, collection, analysis, and interpretation of data, in writing of the report and in the decision to submit the paper for publication.

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