As a health care worker caring for patients who smoke, you know that the best thing you can do for their long term health is to persuade, encourage and facilitate them to quit smoking.
Most smokers want to quit, but they don’t want to be lectured at. Upcoming elective surgery offers an opportunity to open or re-open a discussion with your patient or client about smoking.
Family physicians have probably addressed the issue with patients several times, but as soon as you refer a patient for a surgical opinion, you should address the issue again. “I think you are going to need an operation to fix this problem. I am going to refer you to a surgeon to arrange that. If you do need an operation, your cigarette smoking will be an additional risk factor. You will heal better and get over your operation quicker if you stop smoking before your surgery. The sooner you quit smoking, the better."
Specialists in other areas do not need to become experts on smoking cessation. What they do need to do, is “Ask Advice and Refer”. Ask your patients about their smoking, advise them that in addition to the usual health risks, smoking poses an extra hazard for anesthesia and surgery, and refer them to an appropriate service. In Canada there is the Smokers’ Helpline which is available online or toll-free at 1 877 513-5333. Most other countries have a similar system. Ideally, get the patient to agree to try to quit smoking, and then arrange for a smoking cessation counsellor to call the patient, rather than leave it to the patient to initiate the contact.
Surgeons have to discuss risk factors with their patients as part of getting an informed consent. As they talk about the risks of surgery, including postoperative breathing problems and wound infections, they can advise that the patient can reduce these risks by stopping smoking before surgery. There may also be procedure-specific advantages of stopping smoking, especially with plastic surgical flaps and orthopedic surgery.
When anesthesiologistsor internistssee patients in a pre-admission clinic before surgery, they are looking for risk factors, ways in which they can improve the chances of the patient avoiding complications during anesthesia, and anything which can be done to increase the chance of a successful operation. Smoking is clearly a major risk factor which needs to be considered and discussed with the patient. If the patient agrees to try to stop smoking, then a referral should be made. Patients only remember a small fraction of what they are told in the preadmission clinic, so it is useful to have a prepared handout or a “Quit Card”.
Other health care professionals can support their patients as they try to remain smoke-free. Some pharmacists have become interested in the topic and have a good background to discuss nicotine replacement therapy and other pharmaceutical aids to stopping smoking.
The resources section of this site contains references, powerpoint presentations and posters you may print out and display in your office or waiting room.