"Home health care nurses have access to hard to reach and difficult to treat populations who are at the highest risk for smoking-related diseases," says lead author Belinda Borrelli, PhD, a psychologist at The Miriam Hospital and associate professor at Brown Medical School.
Ninety-eight home health care nurses from the Visiting Nurses Association of Rhode Island were randomly assigned to deliver one of two counseling techniques to 273 patients during routine medical visits – motivational enhancement or standard care.
Motivational enhancement explored a patient's ambivalence to quitting and focused on building the confidence and motivation to quit. These patients also had their carbon monoxide levels measured in order to explain the disease risks associated with that level. The nurses educated patients on the dangers of carbon monoxide using everyday examples they could relate to.
"We communicated to the patients that the carbon monoxide they inhale from smoking cigarettes is the same poisonous gas that comes out of the tail pipe of their car," says Borrelli.
Standard care included the five "A's" of quitting as developed by the Agency for Health Care Policy and Research (AHCPR) - ask about smoking, assess motivation to quit, advise to quit, assist with quitting, arrange follow-up.
"We found that while both types of home-based counseling resulted in individuals quitting smoking or making positive strides towards quitting, those in the motivational enhancement group outperformed the standard care group in every measure," says Borrelli.
Twelve months after the treatment, twice the number of patients in the motivational enhancement group reported continuous abstinence from smoking compared to those in the standard care group. Among patients who were not able to quit, 75 percent of those in the motivational enhancement group had made an attempt to quit compared to 55 percent of those in the standard care group. Furthermore, those in the motivational group reported smoking an average of seven less cigarettes per day versus three less per day of those in the standard care group.
"Home health care nurses form a trusting bond with their patients and are ideal vehicles to promote health behaviors," says Mary Linn Hamilton, CEO of the Visiting Nurses Association of Rhode Island. "By capitalizing on a teachable moment induced by the medical visit, the nurses found patients to be receptive to the counseling."
The authors note that since the counseling was provided as part of routine medical care, patients did not have to be ready and willing to quit to be in the study. In fact, approximately 36 % of the sample expressed no plans to quit at baseline, but were still willing to receive counseling from their nurse.
"Patients that enroll in smoking cessation programs on their own are highly motivated to quit, but represent a very small portion of the smoking population. Using an existing health channel to reach smokers who vary in their motivation level to quit could have a significant public health impact," says Borrelli.
According to recent statistics from the Centers for Disease Control, 20.9% of adults aged 18 and over are current smokers.
The Miriam Hospital, established in 1926 in Providence, RI, is a not-for-profit hospital affiliated with Brown Medical School. Nationally recognized as a top hospital in cardiovascular care, The Miriam Hospital (www.miriamhospital.org) offers particular expertise in cardiac catheterization, angioplasty and women's cardiac care. One of 20 designated Center for AIDS Research (CFAR) sites, The Miriam is a leader in the treatment, research and prevention of HIV/AIDS, attracting $17 million of the world's HIV/AIDS research dollars. The Miriam Hospital has been awarded Magnet Recognition for Excellence in Nursing Services twice and is committed to excellence in patient care, research and medical education. The Miriam is a founding member of the Lifespan health system.
Journal
Preventive Medicine