No Ifs, No Butts: Compliance with Smoking Cessation in Secondary Care Guidance (NICE PH48) by Providers of Cancer Therapies (Radiotherapy and Chemotherapy) in the UK

Abstract

Background: Legislation preventing smoking in public places was introduced in England in July 2007. Since then, smoke-free policies have been extended to the majority of hospitals including those providing cancer therapies. Whilst studies have been conducted on the impact and effectiveness of hospital smoke-free policy in the UK and other countries, there have not been any studies with a focus on cancer care providers. Cancer patients are a priority group for smoking cessation and support and this study aimed to examine implementation of the National Institute Clinical Excellence (NICE) guidance (PH48) in acute cancer care trusts in the UK. Methods: Participants were recruited from UK radiotherapy and chemotherapy departments (total 80 sites, 65 organisations) and asked to complete a 15 min online questionnaire exploring the implementation of NICE guidance at their hospital site. Results: Considerable variability in implementation of the NICE guidance was observed. A total of 79.1% trusts were smoke-free in theory; however, only 18.6% were described as smoke-free in practice. Areas of improvement were identified in information and support for patients and staff including in Nicotine Replacement Therapy (NRT) provision, staff training and clarity on e-cigarette policies. Conclusions: While some trusts have effective smoke-free policies and provide valuable cessation support services for patients, improvements are required to ensure that all sites fully adopt the NICE guidance.

Therapeutic Radiographers' perceptions of the barriers and enablers to effective smoking cessation support

“…Hiscock et al reports over half of smoking cessation personnel would not recommend e-cigarettes to clients 29 . This study and previous work 8 The health community has traditionally been resistant to engaging with the tobacco industry to develop "safer" products containing tobacco or nicotine alone. Although reluctance remains, there is now emerging evidence that e-cigarettes can assist in people cutting down or stopping smoking 30 .…”

“…Furthermore, when the motivation behind quitting were examined, the findings highlighted that health concerns such as tolerating treatment better and fear related to their cancer diagnosis encouraged their decision 37,38,39 . The time around the diagnosis of cancer was found to be an opportune time to offer smoking cessation treatments 8,40 as this demonstrates the effect of the "teachable moment", often described in the literature 41 . In accordance with this study, one may suggest that therapeutic radiographer's opinions and feelings overpower the momentum of the "teachable moment".…”

“…Despite the widespread knowledge of the causal link between tobacco and cancer, evidence shows patients continue to smoke after their diagnosis 8 . The radiobiological effects of continued smoking during radiotherapy treatment are hypoxia induced radioresistance 9 , leading to reduced local control of the tumour 10 .…”

Cancer care clinicians’ provision of smoking cessation support: A mixed methods study in New South Wales, Australia

“…Rather than apply a standard one‐size‐fits all approach to a smoking cessation brief intervention, clinicians described the need for tailored interventions requiring a skillful, supportive, nonjudgmental, and compassionate approach to behavior change, 29 taking into account the acute and chronic stress faced by patients that is often accompanied by shame and guilt. Clinicians expressed concerns about potentially compromising therapeutic relationships in discussing quitting smoking 20 . Smoking cessation discussions between patient and providers have potential to fracture or strengthen trust depending on the communication and interaction during consultations 30 .…”

Attitudes of oncology healthcare practitioners towards smoking cessation: A systematic review of the facilitators, barriers and recommendations for delivery of advice and support to cancer patients

“…However, evidence suggests current interventions are not improving long-term cessation rates in cancer patients 18 which may be attributed to oncology professionals not fully engaging in delivery 19 despite their involvement being key to success 20 . A recent audit of UK radiotherapy and chemotherapy departments indicated less than a third, 32.4%, of departments advised patients to cease smoking during cancer treatment, with only 16.1% reporting to always give information on smoking cessation and available support to patients 21 .…”