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Tobacco Cessation Counseling
The pilot study by Pine et al1 on the implementation of systematic tobacco cessation counseling in a community-based practice suggests that the program is an effective strategy in helping smokers to quit smoking. Smokers were identified during office visits. Those who were ready to quit were referred to a nurse counselor who provided information about how to quit, coping strategies, nicotine replacement therapy, and follow-up support and encouragement. The study showed that advice to quit smoking is most effective when it is provided consistently, over the longest period possible, and by both physicians and nonphysicians.
What compels me to respond to this report is that home health agencies already have the framework of a tobacco cessation counseling program in place. Assessment of smoking status could occur during the initial admission visit at the client's home, when a detailed history is taken and physical examination is performed. Home health nurses could be trained in smoking cessation counseling, and could counsel and support smokers during each visit to the home. Nicotine replacement therapy could be provided by the physician and supervised by the home health nurse.
It may be that a systematic approach to tobacco cessation would work as well in the home health agencies as in physician or dental practices and perhaps would even result in higher quit rates, given the traditionally strong focus of nurses on patient teaching and their desire to care for the whole person.
Counseling of smokers is within the scope of nursing practice and should be accorded high priority within the nursing role. Health care professionals, both physicians and nurses, should not continue to waste a powerful opportunity to modify the patient's most important health risk factor.2
Ann Landmark, RN, BSN
Palatine, Ill
1. Pine D, Sullivan S, Sauser M, David C. Effects of a systematic approach to tobacco cessation in a community-based practice. Arch Fam Med. 1997;6:363-367.
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2. Hollis J, Lichtenstein E, Vogt T, Stevens V, Biglan A. Nurse-assisted counseling for smokers in primary care. Ann Intern Med. 1993;118:521-525.
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In reply
We agree that home health nurses could be trained to provide excellent tobacco cessation counseling and that an effective cessation counseling system involving the home health care nurse could be developed. The findings in our study suggest that nurse counseling will be most effective if all the components of the system are provided consistently. These include identification of tobacco use status, brief advice during health care visits, provision of self-help materials, and telephone follow-up supporting cessation at the time of quit efforts. There needs to be good communication between the physician who is providing brief cessation advice during office visits and the nurse who is providing extended counseling and follow-up. Although it may be challenging to integrate physician and home care nurse counseling services, it seems appropriate to extend tobacco cessation services to the home care setting.
Donald A. Pine, MD;
Susan Sullivan, PhD
Minneapolis, Minn
Arch Fam Med. 1998;7:310.
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