As nurses, we play a vital role in the overall health of our patients, especially where smoking and vaping are concerned. Our silence could mean an early death for some.
About half of patients who smoke or vape will die from a tobacco-related illness. In a 2015 report from the New York Department of Health, 50% of patients stated that they decided to pursue quitting because a healthcare professional recommended it! Here’s how to start . . .
Always Start the Conversation
Make it a habit to always ask about smoking and vaping. Every patient, every time.
I begin with a simple, “Do you smoke or vape?” as a starting point.
When my patients say “Yes, I smoke,” I immediately ask how long they’ve been smoking/vaping. Some are shocked as they calculate the years and others are amused by the number of decades, in a head-shaking sort of way. There’s no scrutiny with the inquiry. My only intention is to gauge their receptivity to starting the conversation of quitting.
Then I ask if they’ve thought about quitting. Overwhelmingly, they always say they have thought of it or have tried to quit in the past, at least once, usually more. I may ask what obstacles they’ve faced or what complications they fear about quitting.
Then I ask, “Are you ready to quit now?” People are honest and some will say no. That’s okay. I encourage them to let me know when are ready so I can be of assistance.
I may also inquire, “What makes you say you’re not ready to quit now?” or “Out of curiosity, what have you tried in the past to quit?” The goal of this question is to set a tone of concern and understanding vs judgment and pressure. I want to be that person they can trust to discuss the hard things. So, if they’re feeling comfortable and opening up, I always nod and say, “Tell me more.”
And if they say yes about being ready to quit, I don’t through the whole kitchen sink full of treatments at them. Instead, I ask, “How I can help you quit?” or “How can I help you succeed in quitting this time?”
Starting the conversation is crucial. Remember, the goal is not to get the patient to quit right there in the clinic room before you send them home but to get them thinking and considering quitting as an option. It’s to get them thinking about succeeding as a non-smoker.
Fear Has Its Place
We are provided gobs of information in nursing school about the end results of tobacco use. From oral and bladder cancer to myeloid leukemia (blood cancer). From COPD (Chronic Obstructive Pulmonary Disease) to heart disease and strokes. It even shows up as cognitive decline and increases risk of Alzheimer’s Disease in later years.
We have scientific support that tobacco (in any form, smoke or vapor) plays a role in all of these conditions and more.
Even though smokers need to understand the seriousness of the damage tobacco is doing to their bodies now and in the future, it remains one of the hardest addictions to quit. It’s not always logical and fear alone cannot move people to action, especially when that fear is in the future in the form of heart disease and COPD.
But Fear Is Not Enough
Smokers already know that tobacco will kill them if they keep up. So why do they continue? Honestly, it doesn’t matter. What matters is that you–the healthcare provider–step up and start the conversation. The majority of adult smokers want to quit and often try (and fail) to quit several times. As nurses, we can educate and support.
Typical concerns about quitting surround support and costs.
- Suggest quitlines as first steps.
1-800- QUIT-NOW is a great place to start. Offering free over-the-phone coaching from a qualified quit coach, this quitline is free of judgment too. This quitline is available in Spanish and several Asain languages as well.
Some quitlines will help smokers create a quitting plan, help find quitting medications, and provide tips on to curb cravings and withdraws. Quitlines are widely available.
2. Remind patients that insurance often covers smoking cessation treatments.
Educating your patients about the treatments available may not be enough if they can’t afford the treatment. In some states, even Medicaid will pay for counseling and medication to quit cigarettes and vaping.
Encourage patients to call their insurance providers and find out what coverage options they have for quitting and then return to discuss options. Remind them to ask specifically about cigarettes and vaping coverage.
3. Know the common concerns about smoking cessation.
Here are the most common questions about smoking cessation that patients ask:
Can I use electronic cigarettes (e-cigs) to transition from smoking cigarettes to quitting?
The U.S. Preventive Services Task Force (USPSTF) does not recommend using e-cigs as a part of smoking cessation treatment. They have concluded there is not enough evidence to support this. The USPSTF recommends the use of established and effective smoking cessation treatments which include counseling and FDA-approved medications.
Why is quitting so hard?
In two words: nicotine addiction. According to the CDC, nicotine is addictive causing temporary surges in the feel-good neurotransmitter dopamine, which reinforces the behavior of using the nicotine. The body becomes used to having the nicotine present and this results in dependence. When the body has to do without the nicotine for a prolonged period of time, it responds with irritability, craving, depression/anxiety, cognitive and attention deficits, sleep disturbances, and increased appetite.
What if I’ve tried before?
Most people attempt to quit two to three times before finding success. Help your patient think through past attempts to quit. What worked? What didn’t work? What can be done differently this time?
Remind patients that there are millions of people around the world who have quit smoking and they can be one of them.
Will I gain weight?
According to Mayo Clinic, weight gain can happen when patients quit smoking, but often it is less than 10 pounds and not everyone will gain weight.
Recommendations for avoiding weight gain include pairing a new smoke-free lifestyle with a healthy diet and moderate activity. Smoking cessation is about an overall healthier lifestyle which includes physical exercise and plenty of fruits and vegetables.
Don’t be afraid to start the conversation. You could be the reason your patient quits smoking or vaping and are on their way to a healthier life.
Cheers,
