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Increasing people's chances of success in smoking cessation

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VOL: 99, ISSUE: 24, PAGE NO: 30

Christine Owens, MHSc, BA, is head of tobacco control at The Roy Castle Lung Cancer Foundation

The Roy Castle Lung Cancer Foundation is the only charity in Europe wholly dedicated to eradicating lung cancer and improving care for patients with lung cancer. It works towards these goals in a number of ways. The foundation:
The Roy Castle Lung Cancer Foundation is the only charity in Europe wholly dedicated to eradicating lung cancer and improving care for patients with lung cancer. It works towards these goals in a number of ways. The foundation:

- Has a patient support network;

- Undertakes research into early detection and treatment of lung cancer;

- Works to prevent young people from starting to smoke through its Kids Against Tobacco Smoke (KATS) campaign;

- Helps adults to stop smoking through its Fag Ends community stop smoking group.

Fag Ends

Fag Ends has been providing smoking cessation support in Liverpool since 1994. The service was initiated using trained volunteers but the advisers are now employees. It grew from a group of people who attended a six-week smoking cessation course run by a multidisciplinary team. Group members felt that they needed to continue to meet and support each other after the course ended.

They went on to receive training on:

- Smoking cessation;

- Groupwork skills;

- Working one-to-one;

- Handling stress;

- Other health-related training courses.

With support from the local health promotion service and local authority, and funding from the Roy Castle Lung Cancer Foundation the group formed Fag Ends. The organisation's coordinator has more than nine years' experience in helping people to stop smoking and since 1999 Roy Castle Fag Ends has been contracted to provide the NHS smoking cessation service for Liverpool.

Service provision

The service runs support groups in more than 40 venues in Liverpool. The groups are distributed across the city in a range of settings, including primary care practices, community association buildings and libraries. People who want to stop smoking can be referred by their GP or other member of the primary care team, or by their hospital consultant or nurse. They can also access the service independently by ringing the free telephone helpline or simply coming to a group meeting. The support groups are ongoing and there is no waiting list.

When people access the service, a Fag Ends adviser will discuss with them in detail their wish to stop smoking, looking for possible barriers to success and ascertaining the most appropriate therapy for each individual. Advisers can provide nicotine replacement therapy (NRT) using a voucher system and may also refer suitable clients to their GP for the prescribing of buproprion.

In addition to the community support groups, one adviser goes into workplaces and two are linked to local hospitals. Fag Ends was recently invited to join a Department of Health pilot, providing a smoking cessation service in working men's clubs, and is providing support in a local club for taxi drivers, which is proving popular.

The organisation offers ongoing support via a free telephone helpline. This is used both to give clients easy access to the service and to act as a readily available back-up to the support given by advisers. Clients calling the helpline can, if they wish, be contacted at specific times - for example, some find it helpful to receive a phone call in the evening of their first day of cessation to reinforce their commitment. Evaluations of the service have shown this additional telephone support is one of the things that clients value.

Fag Ends clients also appreciate the fact that they are encouraged to take control of their own attempt to stop smoking. They decide when they will stop and are encouraged to explore all therapy options before deciding jointly with their adviser which is the most suitable for them.

Smoking cessation rates

According to a DoH statistical bulletin (2002), between April 2001 and March 2002 about 227,300 people in England set a cessation date through the NHS smoking cessation services. Of these, approximately 119,800 had successfully stopped smoking at four weeks - a 53 per cent success rate.

In the same period 6,978 people were referred to Fag Ends. These referrals resulted in 3,091 cessation attempts and 2,231 four-week cessations - a success rate of 72 per cent. This is higher than the 44 per cent cessation rate in the North West of England and significantly higher than the national average of 53 per cent.

The Fag Ends team is recognised for its success and has been approached by West Cheshire Primary Care Trust (PCT) to run sessions in its area. The Cheshire service is run as a rolling programme and clients must be referred back to their GPs for either NRT or buproprion. It has achieved similar success rates to the Liverpool service, demonstrating that the Fag Ends model is transferable.

Why smoking cessation is important

It is recognised by most health professionals and the government that smoking is the single greatest cause of preventable illness and premature death in the UK and it has been estimated that half of all smokers will die prematurely of a smoking-related illness. This results in about 120,000 deaths annually (DoH, 1998). Smoking is implicated as a causal or contributory factor in a large number of diseases including lung cancer, cardiovascular disease, peripheral vascular disease, respiratory diseases such as chronic obstructive pulmonary disease, bronchitis and emphysema. It is estimated to cost the NHS £1.5bn a year (NICE, 2002).

Helping people to stop smoking Health professionals have a responsibility to advise and encourage smokers to stop. For this to be effective they need to support clients in their attempts to do so. This support can include recommending both NRT and buproprion. Department of Health targets for smoking cessation over the next three years have increased significantly. If PCTs are to meet these targets, all health professionals will have to play their part in helping clients to stop smoking.

Approximately 80 per cent of the population visit their GP at least once a year (Fowler, 1997). The primary care setting is therefore an important way of reaching smokers and encouraging them to stop smoking. This can include giving brief advice on smoking cessation followed by referral to a specialist smoking cessation service like Fag Ends, if more intensive support is required. Bupropion or NRT should be prescribed if they are likely to increase the person's chance of success.

Guidelines on smoking cessation recommend that all professionals in the primary health care team should be encouraged to ask about smoking and advise smokers to stop. They also recommend that hospital inpatients and outpatients who smoke should be routinely offered specialist smoking cessation support (Raw et al, 2002).

Providing information for clients In the course of their work

Fag Ends advisers found that they needed access to non-branded, unbiased information to help them discuss the smoking cessation therapies available to clients. This had also been acknowledged in other areas - in particular the smoking cessation service in Hyndburn and Ribble PCT, where staff had developed their own smoking cessation toolkit containing samples of each product. In a similar vein the Fag Ends team set about producing The Essential Quitting Guide: a helpful guide to stopping smoking.

Fag Ends was keen to ensure that its guide would be useful to primary care teams, and spoke to local teams who provide intermediate smoking cessation advice to smokers. It was clear from these discussions that there was a real need for additional product information in the primary care setting. The Fag Ends hospital advisers also found that practitioners in secondary care would benefit from this resource.

Having looked at what was available the team decided that the guide should include a specific presentation pack to give information about all NRTs and bupropion. This was seen as important because most of the people who successfully use smoking cessation services use these products. In 2001-2002, 63 per cent received NRT only, 19 per cent received bupropion only, and 2 per cent received both (DoH, 2002).

The team realised that the pack would need to be portable and easy to use, as many specialists are based in the community. It was also decided that it should be available at no charge to smoking cessation services and practice nurses.

Fag Ends smoking cessation advisers tested the prototypes of the guide. It was then revised in the light of their experiences to ensure that the end product was as useful as possible in helping smokers to stop.

Using the guide

The guide helps health professionals to talk to patients and clients about smoking cessation in any setting and gives details about all the therapies available to support smoking cessation. It recognises different approaches to smoking cessation and helps determine the most suitable product for each individual client.

The guide contains a range of general questions that clients tend to ask. These are followed by some that are more specific. Questions include: How can treatments help? How do I know which product is best for me? What will happen if I start smoking again?

The products available to support smoking cessation are listed, together with pictures of the products and answers to questions such as: What is it? What types are available? How do they work? Why might they suit me?

The guide replaces many pharmaceutical company leaflets previously used with clients and includes questions and answers about how to use nicotine patches, gum or lozenges most effectively. Clear, concise, factual information is presented in two user-friendly formats:

- An A4 version, which has been circulated nationally to smoking cessation services established as a result of the government White Paper Smoking Kills (DoH, 1998). This is for use in group counselling or individual settings. A guidance booklet containing frequently asked questions and answers on nicotine replacement therapy and buproprion is also included with the A4 folder.

- An A5 guide, which has been distributed to all GP practices that offer smoking cessation support. This is for use in one-to-one sessions, for example, during a general check-up with a practice nurse, before referral to a specialist service.

To obtain a copy of the guide contact Christine Owens, head of tobacco control, at The Roy Castle Lung Cancer Foundation on 0151 794 8908.

For further details visit:
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