Perioperative tobacco use treatments: putting them into practice

Abstract

Treatment for tobacco use is efficacious and beneficial to health. Although guidelines recommend that all patients who use tobacco are offered treatment as a part of their clinical care, implementing treatment has proven challenging. In the case of surgical patients, this lack of treatment is particularly unfortunate, as the benefits of abstinence from tobacco are immediate in terms of reducing the risk of surgical complications, including cardiovascular, respiratory, and wound related complications. Surgery also presents an opportunity for patients to quit for good and reduce the long term health risk. This review examines the principles of tobacco use treatment, the rationale for tobacco use treatment in the perioperative period, and how treatment can be incorporated into the routine care of surgical patients. The discipline of implementation science helps to frame these efforts by seeking to better understand how changes in clinical practice occur, and it has the potential to guide an evidence based approach to embedding tobacco treatment into the routine clinical care of surgical patients. This review uses the consolidated framework for implementation research, which includes five major domains, as a representative conceptual framework. A basic understanding of factors potentially important to successful implementation can help to guide clinicians who accept the challenge of implementing tobacco use treatment in surgical care.

Fast-track implementation of clinical health promotion

“…Building on the evidence of the effects of SNAP interventions on diseases (7)(8)(9)(10)(11)(12)(13)(14), the evidence on the effect of adding CHP to clinical treatment (22)(23)(24)(25) and recognizing the known challenges related to implementation (1,3,15,18,(26)(27)(28), the research project behind the thesis was planned in 2011 (1). (31).…”

“…Despite effects (7-11, 14, 53, 80), the increasing evidence for CHP is still not commonplace nor systematically implemented (1,3,15,18,(26)(27)(28). A wide range of factors may offer explanations as to why implementation is not taking place; staff may lack CHP competencies and management support, organizational cultures and structures might be a barrier and resources might be lacking (15,28,81,82).…”

“…Despite effects (7-11, 14, 53, 80), the increasing evidence for CHP is still not commonplace nor systematically implemented (1,3,15,18,(26)(27)(28). A wide range of factors may offer explanations as to why implementation is not taking place; staff may lack CHP competencies and management support, organizational cultures and structures might be a barrier and resources might be lacking (15,28,81,82). In addition, SNAP among staff and managers themselves might also play a role (82)(83)(84)(85), and supportive tools or strategies may be needed (1)(2)(3) As recognized by implementation science (37), specific investigation of the implementation of new evidence in practice is warranted (16,20,37,86).…”

“…Considering the results of integrating CHP in treatment (22)(23)(24)(25), it seems that attempts to bring more effective CHP to patients are matters of clinical quality (1,2,15,26,27).…”

“…Revised quality plan Owing to its roots in health promotion (19), and its widespread use (159), RE-AIM may be considered an obvious candidate for the Fast-IM on CHP (15). In particular, it may prove helpful for furthering adequate reporting and transparency regarding the possible delays in incorporation of CHP into practice in hospitals (2).…”