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What is the best treatment modality for smoking cessation

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WHAT IS THE BEST TREATMENT MODALITY FOR SMOKING CESSATION? Evidence-Based Practice ... interventions should serve as adjuvant therapies to medications to increase ... – PowerPoint PPT presentation

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Title: What is the best treatment modality for smoking cessation


1
Evidence-Based Practice
  • What is the best treatment modality for smoking
    cessation?

By Brandi Fuselier, Courtney Garner, Rachael
Robison, Katy Stewart
2
Identification of Problem
  • Smoking
  • LEADING CAUSE OF PREVENATBLE DEATHS WORLDWIDE
  • RELATED TO MANY HEALTH PROBLEMS
  • Every 8 seconds one person dies from tobacco use
  • Cigarettes cause 1 out of 5 American deaths
  • Smoking-related diseases cost the united states
    more than 150 Billion a year

3
Identification Of Problem
  • Healthy people 2010- Reduce tobacco consumption
    by 12
  • Approximately 51 of smokers attempted cessation
    last year in the united states
  • Unaided smoking cessation has been found to only
    have success rates of 2-4
  • First-line therapy has traditionally been
    pharmacological agents
  • Limited research on effectiveness of
    non-pharmacological treatments in sustaining
    abstinence

4
PICO
  • PATIENT POPULATION OF INTEREST IS SMOKING ADULTS
    AGES 18 AND OVER
  • INTERVENTION OF INTEREST IS THE USE OF
    NONPHARMACOLOGICAL AGENTS (SUCH AS GUIDED
    IMAGERY, QUITLINES, EXERCISE)
  • Comparison of interest is pharmacological agents
  • Outcome of interest is effectiveness in smoking
    cessation

5
EBP Question
  • IN ADULTS AGES 18 YEARS AND OLDER IS THE USE OF
    NON-PHARMACOLOGICAL AGENTS (SUCH AS GUIDED
    IMAGERY, QUITLINES, AND EXCERISE) IN COMPARSION
    TO PHARMACOLOGICAL AGENTS MORE EFFECTIVE IN
    SMOKING CESSATION?

6
Review of Literature
  • What is being done to study the problem?
  • Medical research
  • Randomized control trials
  • Systematic Reviews
  • Literature Reviews
  • Clinical Guidelines
  • Case studies
  • Inadequate nursing research

7
Review of Literature
  • pros of using Non-pharmacological agents
  • Little to no adverse/ side effects
  • No prescription needed
  • May not require visit to PCP to initiate
    treatment
  • Majority are cost effective
  • Wide variety of options

8
Review of Literature
  • Cons of using Non-pharmacological agents
  • May not be as readily available to consumers
  • May require more time and effort
  • Lack of health care provider knowledge regarding
    options

9
Review of Literature
  • Guided Imagery
  • Involves using the imagination and mental images
    to promote relaxation, changes in attitude, or
    behavior, and encourages physical healing.
  • Helps reduce stress
  • Audio CDs available to guide clients through
    the process .
  • Specially trained nurses on guided imagery.
  • http//www.academyforguidedimagery.com

10
Review of Literature
  • Non-pharmacological Studies - Guided Imagery
  • Guided imagery was twice as effective as
    Bupropion (Zyban) (Grohs et al. 2008).
  • Guided imagery was more effective than counseling
    alone (Wynd, 2005).

11
Review of Literature
  • Exercise
  • Individuals are often afraid to stop smoking for
    fear of weight gain.
  • Types of exercise helpful to those attempting
    smoking cessation include weight-bearing,
    cardiovascular, and stretching.

12
Review of Literature
  • Non-pharmacological Studies - Exercise
  • Exercise was shown to aid in withdrawal symptoms
    associated with nicotine dependence (Usser,
    Taylor, Faulker, 2008).

13
Review of Literature
  • Common Quitlines
  • 1-800-QUITNOW
  • 1-877-NOBUTTS

14
Review of Literature
  • Non-pharmacological Studies Quitlines
  • More effective than brief counseling from a
    healthcare provider or self-help materials alone
    (Stead, Perera, Lancaster, 2007).
  • Effective in addressing the needs of large
    populations and enabled those in rural areas to
    obtain support with smoking cessation efforts
    (Lichtenstein, Glasgow, Ossip-Klein, Boles,
    1996).

15
Review of Literature
  • Pros of using pharmacological agents
  • Increased availability of OTCs
  • Various forms of Nicotine Replacement Therapy
  • Easy to use, time efficient
  • More knowledge and research available

16
Review of Literature
  • cons of using pharmacological agents
  • May require prescription
  • Adverse side effects
  • Expensive

17
Review of Literature
  • Pharmacological Studies
  • Nicotine Replacement Therapy, Varencicline
    (Chantix), Bupropion (Zyban), were effective in
    sustaining both short-term and long-term
    abstinence from smoking(Wu, Wilson, Dimoulas,
    Mills, 2006).
  • Varencicline (Chantix) superior to both NRT (in
    indirect study comparisons) and Bupropion (Zyban)
    (Wu, Wilson, Dimoulas, Mills, 2006).
  • All of the available types of NRT increased
    abstinence rates 1.5 to 2-fold (Silagy,
    Lancaster, Mant, Fowler, 2004).

18
Review of Literature
  • Pharmacological Agents Mechanisms of
    Action/Side Effects
  • NRT
  • Releases constant amounts of nicotine throughout
    the body using a tapering-off method.
  • Available in several forms
  • Side Effects skin irritation (patch),
    dizziness, racing heart rate, sleeping
    difficulties, headache, vomiting, muscle aches,
    and stiffness.

19
Review of Literature
  • Pharmacological Agents Mechanisms of
    Action/Side Effects
  • Varencicline (Chantix)
  • Limits dopamine release and effectively blocks
    nicotine receptors in brain.
  • Available in tablet form.
  • Side Effects sleeping difficulties,
    constipation, vomiting, flatulence, gingivitis,
    chest pain, influenza-like symptoms, edema, and
    thirst.

20
Review of Literature
  • Pharmacological Agents Mechanisms of
    Action/Side Effects
  • Bupropion (Zyban)
  • Atypical antidepressant norepinephrine
    dopamine reuptake inhibitor
  • Available in extended-release tablets
  • Side Effects anxiety, sleeping difficulties,
    seizures, dizziness, drowsiness, dry mouth, loss
    of appetite, abdominal pain, constipation, and
    diarrhea.

21
Recommendations
  • 1. A comprehensive program that includes
    pharmacological agents as first-line therapies is
    supported.
  • 2. Non-pharmacological interventions should serve
    as adjuvant therapies to medications to increase
    clients rates of sustained abstinence from
    smoking.
  • 3. Treatment plans should be individualized and
    tailored specifically to each client in order to
    ensure positive outcomes

22
Literature Supporting Recommendations
  • Both pharmacological and non-pharmacological
    treatment options address the various needs of
    the individual seeking smoking cessation.
  • Combining non-pharmacological and
    pharmacological modalities and tailoring to the
    individual yields the best smoking cessation
    rates (Mundey, 2009).
  • National Guideline Clearinghouse supports a
    multidimensional approach to smoking cessation.

23
Current Practice
  • HOSPITAL A
  • HOSPITAL B
  • HOSPITAL C

24
Implementation Strategies
  • Multidisciplinary Approach
  • Awareness Campaign
  • In-services (CEUs)
  • Cafeteria posters/pamphlets
  • Web-based materials
  • PSAs (through television/radio)
  • Admission assessment
  • Designated smoking cessation experts on floors
  • Recycling information (at specific time
    intervals)

25
Evaluation of Effectiveness
  • Multidisciplinary Approach
  • Client healthcare team satisfaction
  • Awareness Campaign
  • Short Term
  • In-services evaluation forms
  • Smoking history reassessment
  • Follow-up phone calls questionnaires
  • Development of focus groups
  • Long-Term
  • Assess the number of individuals enrolled in
    smoking cessation programs.
  • Assess hospital readmission rates for
    smoking-related complications

26
Suggestions for Further Study
  • What are other approaches to studying the
    identified problem?
  • Long-term randomized control trial studies
  • Specific studies comparing pharmacological and
    nonpharmacological interventions
  • Studies on nursing related interventions
  • Larger sample sizes
  • Patient surveys

27
Suggestions for Further Study
  • What new research questions have emerged as a
    result of the project?
  • Why are long-term abstinent rates so low?
  • What are ways to overcome barriers to successful
    smoking cessation?
  • What is the most effective non-pharmacological
    treatment for smoking cessation?
  • What types of physical activity including
    intensity levels are best for smoking
    cessation?

28
Future Therapies
  • Nicotine Vaccine
  • Rimonabant
  • Pharmacogenetics

29
Questions
30
References
American Lung Association (2009). Quit smoking
benefits. Retrieved March 29, 2009 from
http//www.lungusa.org/site/c.dvLUK9O0E/b.33568/k
.CEBD/Benefits.htm. Grohs, U., Kemmler, G.,
Kriechbaum, N., Saria, A., Wallner, R., Zernig,
G. (2008). A randomized trial of short
psychotherapy versus sustained-release bupropion
for smoking cessation Electronic version.
Addiction, 103, 2024-2031. Institute for
Clinical Systems Improvement. (2004). Tobacco use
prevention and cessation for adults and mature
adolescents. National Guideline Clearinghouse,
1-25. Lichtenstein, E., Glasgow, R. E.,
Ossip-Klein, D. J., Boles, S. M. (1996).
Telephone counseling for smoking cessation
Rationales and meta-analytic review of evidence.
Health Education Research Theory Practice,
11(2), 243-257. Mundey, K. (2009). An appraisal
of smoking cessation aids. Current Opinion in
Pulmonary Medicine, 15, 105-112.
31
References
Silagy, C., Lancaster, T., Mant, D., Fowler, G.
(2004). Nicotine replacement therapy for smoking
cessation. Cochrane Database of Systematic
Reviews, 3, 1-8. Stead, L. F., Perera, R.,
Lancaster, T. (2007). A systematic review of
interventions for smokers who contact quitlines.
Tobacco Control, 16(1), 3-8. Ussher, M., Taylor,
A., Faulker, G. (2008). Exercise interventions
for smoking cessation. Cochrane Database of
Systematic Reviews, 4, 1-37. World Health
Organization (2009). Smoking statistics.
Retrieved March 29, 2009, from http//www.wpro.wh
o.int/media_centre/fact_sheets/fs_20020528.htm.
  Wu, P., Wilson, K., Dimoulas, P., Mills, E.
(2006). Effectiveness of smoking cessation
therapies A systematic review and
meta-anaylsis. Biomed Central Public Health, 6,
300-316. Wynd, C. (2005). Guided health imagery
for smoking cessation and long-term abstinence
Electronic version. Journal of Nursing
Scholarship, 37, 245-250.
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