Clinician-delivered Intervention to Facilitate Tobacco Quitline Use by Surgical Patients

Warner, David O.; Klesges, Robert C.; Dale, Lowell C.; Offord, Kenneth P.; Schroeder, Darrell R.; Shi, Yu; Vickers, Kristin S.; Danielson, David R.

doi:10.1097/aln.0b013e31820d868d

Cited by 37 publications

(29 citation statements)

References 19 publications

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“…This approach, referred to as a teachable moment (TM), involves proactively soliciting a smoker’s willingness to receive treatment for nicotine dependence during a life event or transition where the salience of the adverse health consequences of smoking is heightened [6]. Previous studies have documented the potential of TMs to promote smoking cessation during physician visits, early detection screening, pregnancy, and surgery [7-10]. …”

Section: Introductionmentioning

confidence: 99%

Is a cancer diagnosis a teachable moment for the patient’s relative who smokes?

Schnoll

Wileyto

Leone

et al. 2013

Cancer Causes Control

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Purpose This study examined a cancer diagnosis, vs. orthopedic surgery, as a teachable moment for recruiting smokers and treating nicotine dependence among patients’ relatives. Methods Cancer patients and, for comparison, orthopedic patients at the University of Pennsylvania Health System were approached for referrals of relatives for a smoking cessation program, which involved behavioral counseling and nicotine patches. Primary outcomes were rate of program enrollment and rate of smoking abstinence. Potential mediators of smoking cessation were explored (e.g., treatment adherence, depression, anxiety). Two-hundred thirty four relatives (113 cancer, 121 orthopedic) were considered eligible for the cessation program and comprised the study sample. Results Relatives of oncology patients were significantly more likely to enroll in the smoking cessation program, vs. orthopedic relatives (75% vs. 60%; OR=1.96, 95% CI: 1.07-3.61, p=.03) but they were not significantly more likely to remain in the program (61% vs. 52%) or quit smoking (19% vs. 26%; p’s > .05). Compared to orthopedic relatives, oncology relatives showed significantly lower nicotine patch adherence and significantly greater levels of negative affect and depression and anxiety symptoms during treatment (p’s < .05). Further, orthopedic relatives, compared to oncology relatives, showed a greater reduction in the perceived benefits of smoking (p=.06), which was significantly associated with abstinence (p=.02). Conclusions While a family member’s cancer diagnosis may serve as a teachable moment for a smoker to enroll in a smoking cessation treatment program, high levels of psychological distress and perceptions of the benefits of smoking and low levels of treatment adherence may undermine successful abstinence among this population.

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Section: Introductionmentioning

confidence: 99%

Is a cancer diagnosis a teachable moment for the patient’s relative who smokes?

Schnoll

Wileyto

Leone

et al. 2013

Cancer Causes Control

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“…Further studies are needed to measure the effects of anesthesiologist-initiated primary care referrals, but analogous care coordination interventions have been shown to improve chronic disease outcomes in several other healthcare contexts. 30,53–60 …”

Section: Discussionmentioning

confidence: 99%

Preoperative Depression Symptom Severity and Its Impact on Adherence to Preoperative Beta-Blocker Therapy

Schonberger

Feinleib²,

Holt³

et al. 2014

Journal of Cardiothoracic and Vascular Anesthesia

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Objective 1) To test the association among depression symptoms, distressed personality-type, and preoperative beta-blocker non-adherence. 2) To estimate the prevalence of untreated major depression in this population. Design Prospective Observational Study Setting A Veterans hospital Patients 120 subjects on outpatient beta-blocker therapy presenting for surgery. Interventions The Patient Health Questionnaire (PHQ)-9, the D-Scale-14 (DS14), and Modified Morisky Scale (MMS) questionnaires. Measurements and Main Results Of 99 participants who presented for surgery, the incidence of preoperative non-adherence was 14.1% (95% CI 7–21%), consistent with prior research. Non-adherence was 9.5% among those with no depression, 27.8% among those with mild depression, and 28.6% among those with moderate to severe depression (Cochrane-Armitage test for trend p=0.03). Distressed personality-type was found in 35% of the cohort (95% CI 26–45%) and was not associated with beta-blocker non-adherence (Fisher’s exact p=0.24). Among participants with symptoms of Major Depressive Disorder (N=25, 25.3%), over half (N=14, 56%) had no indication of depression listed at their most recent primary care visit. Conclusions Patients with symptoms of depression on chronic beta-blocker therapy are prone to medication non-adherence on the day of surgery. The majority of surgical patients with symptoms of major depression lack a diagnosis of depression. Preoperative depression screening may thus 1) identify a population at increased risk of beta-blocker withdrawal and 2) identify patients who may benefit from anesthesiologist-initiated referral for this treatable condition.

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“…With even greater potential impact, they have proposed a perioperative preventive health maintenance clinic. This clinic relates to work that I and others have been advocating [12][13][14] whereby the perioperative team screens for modifiable preventive health risk factors such as missing vaccinations, poor blood pressure control, and hyperlipidemia among surgical patients.…”

Section: Associate Editor's Notementioning

confidence: 95%

Rebranding the Perioperative Surgical Home: Lessons From the Duke Experience

Schonberger

2016

Journal of Cardiothoracic and Vascular Anesthesia

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Clinician-delivered Intervention to Facilitate Tobacco Quitline Use by Surgical Patients

Cited by 37 publications

References 19 publications

Is a cancer diagnosis a teachable moment for the patient’s relative who smokes?

Is a cancer diagnosis a teachable moment for the patient’s relative who smokes?

Preoperative Depression Symptom Severity and Its Impact on Adherence to Preoperative Beta-Blocker Therapy

Rebranding the Perioperative Surgical Home: Lessons From the Duke Experience

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