Core Competencies – Health Professionals and Tobacco

Elin Roddy

BASSP

September 2007

Aims and Objectives

• To ensure that all NHS staff directly involved with patient care meet a basic set of core competencies to enable them to identify and support smokers who want to stop smoking

• http://www.brit-thoracic.org.uk/cessationcompetencies

Where this fits – NICE guidance

• Brief chats between people who smoke and health professionals about stopping smoking are both effective and cost effective in helping people to stop smoking.

• All health professionals should advise all smokers to stop smoking, not just those who are already ill

• Advice should be sensitive to individual needs.

NICE public health guidance: focus on smoking cessation and physical activity http://www.nice.org.uk/page.aspx?o=300139

The role of the health care professional - what prompted an attempt to stop smoking?

0 5 10 15 20 25 30 35 40

Family/friend

Health professional

Advert

Poster

Restrictions

Health Problem

%%Base: 672 smokers currently trying to stop or made attempt to stop in past year.Base: 672 smokers currently trying to stop or made attempt to stop in past year.West R. Getting Serious About Stopping Smoking. A Report for No Smoking Day 1997West R. Getting Serious About Stopping Smoking. A Report for No Smoking Day 1997

Aims and Objectives

• Knowledge

• Skills

• Attitudes

• Additional competencies for prescribers

Knowledge

• Effects of smoking on health

• Implications of addiction to nicotine

• Cessation strategies available to help smokers to quit

• Local smoking cessation services available

Benefits of quitting smoking Benefits of quitting smoking

Men Women

Lifeexpectancy

Extra yearscompared to

smokers

Lifeexpectancy

Extra yearscompared to

smokers

Smoked until death

69.3 73.8

Never smoked 78.2 8.9 81.2 7.4

Quit at age 35 76.2 6.9 79.9 6.1

Quit at age 45 74.9 5.6 79.4 5.6

Quit at age 55 72.7 3.4 78.0 4.2

Quit at age 65 70.7 1.4 76.5 2.7

Taylor et al, AM J Public Health 2002;92:990-6

Speakers notes:

Smokers die earlier than non-smokers.The estimated gain in life expectancy from quitting at given ages is clinically significant at all ages.If the pension age goes up to 70, then most male smokers will die before they collect their pension.

________________

Taylor DH, Jr., Hasselblad V, Henley SJ, Thun MJ, Sloan FA. Benefits of smoking cessation for longevity. Am J Public Health 2002;92:990-6

Skills

• Identifying all smokers

• Delivering brief opportunistic smoking cessation advice to all smokers

• Assessment of patient’s commitment to quit

• Referring to local specialist smoking cessation services

Understanding smoking behaviour

• Health effects of nicotine/ smoke• Withdrawal syndrome• Address misconceptions around quitting:

• ‘Smoking helps me deal with stress’• ‘I’ll put on weight’• ‘The odd one won’t hurt’• ‘I’ve switched to roll ups’

Attitudes

• Non-judgemental approach to smokers • Acknowledge role of addiction and

importance of support

- Most smokers do not choose to smoke but do so because they are addicted

- Most smokers will not be able to give up without support

- Smokers have equal rights too

Additional slides – specialty specific health effects and additional competencies for prescribers

Smoking Cessation by specialty

RespiratoryOncologyCardiologyGastroenterologyRheumatologySurgeryPsychiatryPaediatricsPregnancy

QOL and Survival in Lung Cancer

• Current smoking is predictor of shortened lung cancer survival*

• May be mediated by biologic effects

• Graces et al: Persistent smoking negatively impacted QOL scores

*Tammemagi, CHEST January 2004

Effects of smoking on health - Effects of smoking on health - Psychiatry• Studies on people with mental illness living in the

community show high smoking rates - 70% in people with schizophrenia, 56% with depression (vs. 28% of population)

• People with severe mental illness tend to smoke more cigarettes per day and have a high morbidity and mortality from cardiovascular and respiratory disease

• However, mental health problems do not undermine the ability to stop smoking.

• Stopping smoking does not appear to exacerbate psychotic symptoms and that experience of depression does not affect quit rates.

• Patients with mental health problems need equality of access to smoking cessation support.

Additional skills for prescribers

• Knowledge of indications for and side-effects of nicotine replacement therapy and bupropion

• Skills in prescribing the above treatments to support a quit attempt

Speed of nicotine delivery

Cut Down Then Stop (CDTS)

• New indication for NRT• Using NRT to reduce number of cigarettes by

50% leads to long-term cessation• Nicorette gum and inhalator now licensed for this

indication• Useful for eg. smoke-free hospitals, where

patients may not want to quit but need to reduce number of cigarettes smoked

Assessment Questions

• Questions have four stems each of which may be true or false, apart from Question 4 where only one stem is correct

• Answers can be found in the speakers notes accompanying each question

Question 3 – Cessation strategies

1. Half of smokers would like to stop smoking

2. Willpower alone is the most effective way to stop smoking

3. Around a quarter of those smokers trying to quit do so because of advice from a health professional

4. Switching to roll-ups is less harmful than smoking cigarettes

Summary

• A free and (hopefully) useful resource

• Available via the BTS website at

• http://www.brit-thoracic.org.uk/cessationcompetencies

• Comprehensive speaker’s notes enable ‘non-experts’ to teach on tobacco

• Overall aim is to broaden the reach of smoking cessation advice

Acknowledgements

• British Thoracic Society Tobacco Committee• David Ross• Angela Hurlstone, Chris Routh, Sheila Edwards