Stopping smoking for even a short time before surgery significantly improves surgical outcomes and increases the likelihood that a patient will survive surgery. Because of this, and because surgery can provide a good opportunity to effectively connect with smokers, the Society for Vascular Surgery and the Society for Vascular Nursing this week issued a joint statement encouraging vascular surgery teams to provide treatment for tobacco dependence for all smokers who are considering surgery.
Unfortunately, too often the manner in which smokers are approached within health care is ineffective, or even detrimental. Sometimes patients are lectured about the health risks they face if they don’t stop. If the person being lectured has tried to stop and ‘failed’ or if they feel stopping smoking is too difficult, this can cause shame, discouragement, or even unconscious discounting of the message. None of which are helpful.
Other times people are given a limited ‘yes or no’ choice. ‘Do you want help to stop smoking?’ Unfortunately the lack of accurate information about treatment, or the fear that treatment means more lectures about smoking and health, too often results in a ‘no’, or ‘not at this time’. Also, people usually think, incorrectly, that tobacco dependence counseling means they must be already committed to stopping or a 'quit date'.
We are looking at more proactive ways to make referrals within surgical groups, or other medical areas in which stopping smoking can be of enormous benefit. We are piloting projects in which we automatically provide treatment as usual care, or ‘opt-out’ rather than ‘opt-in’ approaches. For example, prior to surgery a patient who smokes will automatically have scheduled a visit with a Tobacco Treatment Specialist (TTS). The TTS is trained to connect with patients, engender hope, provide education and options, respect a patient’s personal choice, and provide treatment as indicated. A trained TTS doesn’t admonish a person for smoking, instead the TTS uses an empathic strength based approach to inform and build confidence.
Here we would like your opinion. What are your thoughts about ‘opt-out’ rather than ‘opt-in’? Should patients automatically be referred to treatment and support for stopping smoking? Or should we first ask if they ‘want help’ with the ‘yes or no’ as a final answer? Or, should we just give them a brochure or contact information and encourge them to call a tobacco quitline?
We would also like to hear from you about any good and bad experiences you have had in health care encounters when tobacco use was broached.
Thanks as always!