Linda P. Sarna, DNS, RN, FAAN: The Success of Nursing-led Interventions for Smoking Cessation
Linda P. Sarna, DNS, RN, FAAN
UCLA School of Nursing, Los Angeles
Past-ONS Distinguished Researcher Recipient
This interview discusses the benefits associated with oncology nurse run telephone quitlines in helping smokers to quit, and gives an overview of various modalities and approaches now used to help people overcome this powerful addiction.
The Group Room at the 2011 Oncology Nursing Society Research Conference is my possible, in part, by:
Selma R. Schimmel, Founder, Vital Options International
This is Selma Schimmel in Los Angeles at the Oncology Nursing Society, ONS, eleventh research conference, and our discussions continue. Now I’m joined by, actually an old from the group- oncology nurse, Linda Sarna. How are you, Linda?
Linda P. Sarna, DNS, RN, FAAN, UCLA School of Nursing, Los Angeles
I’m delighted to be here.
Selma R. Schimmel:
And you are a woman of distinction here at ONS. You are the past ONS distinguished researcher and you have an expertise in lung cancer and smoking prevention and cessation.
Linda P. Sarna:
That’s right. It’s interesting, this is the eleventh meeting. They meet about every two years and I was at the very first meeting. And my research there was on people dying with lung cancer and at the later part of my career I focused on quality of life issues of people living with lung cancer, in particular. And I couldn’t ignore the tobacco issue and actually how continued tobacco use also complicated their treatment and their recovery and even end of life care. So with this conference I’m talking about some of the research that we’re doing to try to translate evidence into practice and really help nurses with patients quitting smoking in the hospital.
Selma R. Schimmel:
Let’s talk about some of the cessation programs and let’s begin with the telephone quit line.
Linda P. Sarna:
Yes. One of the… here we’re presenting some data for a study funded by the Centers for Disease Control called Helping Smokers Quit. What we wanted to do was to translate the evidence-based practice, Tobacco Dependence Treatment Guideline, into the hospital setting so that every smoker who interacted with a nurse was able to get the resources to quit. Now we know from our studies that, from the research that people will make quit attempts in the hospital, because you can’t smoke anymore, and they may be smoke-free, but when they go home it’s very difficult and they can lapse back into their addiction. And so, we know that one of the things that needs to happen is that there needs to be some follow-up. Now with our healthcare situation the way it is, it’s hard for the nurse or the doctor, anyone to give that call, “how are you doing?” However, the telephone quit line 1-800-QUIT-NOW is a free resource for smokers throughout the country. They can call up the quit line, every single state, they can get print material and they’ll also be able to speak with the trained counselor who will ask them about their history with smoking. Most smokers have tried to quit before, what they’ve used and explore with them different options. And we know that the gold standard right now is providing people with counseling and support, and also using some of the FDA approved medications. So in our study, what we wanted to do, this is the base-line information; we decided to go to three states. We went to nurses in California, nurses in Indiana and nurses in West Virginia. Obviously, in California we have the second to the lowest smoking prevalence in the state but still, in LA County alone we have over a million smokers. West Virginia, Indiana, very high smoking prevalence. We wanted to see if there was a difference in the culture of interventions by the nurses. What we found was not surprising. It was that overall we’ve done much better with asking about tobacco use and very poor about intervening to actually help people quit. And very, very few nurses actually refer smokers to the quit line. They don’t know about this resource, and that’s the goal of this research; eventually, is to make sure everyone is aware.
Selma R. Schimmel:
When someone calls the quit line, will the nurse then work with the caller to ensure that they get into the proper physician or program to help if they should need one of these FDA approved drugs to help them through the process, or whatever modality they choose. Is there that kind of follow-up support?
Linda P. Sarna:
Well, each state operates a little bit differently. In California, for example, if a smoker calls the quit line, they must initiate the call. In other states, they can fax a referral to the quit line so that the nurse actually… and the quit line calls the patient. Many quit lines do have a procedure, a format to give feedback to physicians. Some quit lines also are able to provide pharmacotherapy, especially for low income or Medicare patients, but not all. So it is a little different state by state.
Selma R. Schimmel:
If you’re able to overcome the urge, the craving, what’s going on with you physiologically as you eliminate that nicotine from your system and your ability to sustain a smoke-free life?
Linda P. Sarna:
So, let me approach this from a couple of ways. First of all, the craving, unfortunately, can last for years. It’s a funny kind of thing because tobacco, nicotine addiction is really a brain disease. You have receptors in your brain, which we didn’t appreciate until really recently, that when you get that hit from a cigarette it takes about nine to eleven seconds to go directly to your brain and it lights up those nicotine receptors and it feels good. And when those nicotine receptors don’t get the nicotine, they feel bad and you get the withdrawal. What happens when you quit smoking is that the nicotine receptors sort of quiet down, they get used to not being fed the nicotine. If you’re on the nicotine replacement, most of the over-the-counter medicine lasts about three months.
Selma R. Schimmel:
The nicotine replacement, does it stimulate the same brain receptors?
Linda P. Sarna:
Yes, it sort of helps blunt the withdrawal. It doesn’t get the same high as a cigarette. Now there are some other medications that don’t replace nicotine but they decrease your desire for smoking. So they’re, they also influence the brain and you’re just not as interested. So those are very important medications too. And generally, people take those a little longer. They also, usually, need a loading dose until you have a level and then you can start; whereas the nicotine replacement medications, you put out that cigarette and then you start. And that’s why it’s so important in the hospital because when people go into the hospital, smoker or not, they’re going to be in a force-quit attempt when they’re in an environment where you cannot smoke, inside hospitals.
One thing we know from the surgeon general report though, is that there is no such thing as a safe cigarette and there’s no such thing as a safe level of smoking. It’s sort of like if you look at just a little bit of heroin, just a little bit of arsenic, it still does many, many damaging things to many parts of your body. And again, as an oncology nurse we know it’s associated with thirty percent of all cancer deaths. Thirty-percent. Not just lung cancer- cervical cancer, leukemias, colon cancer, pancreatic cancer, head and neck cancers, esophageal cancer, bladder cancer… I could go on and people aren’t as aware of all of those other cancers.
Selma R. Schimmel:
When you look at everything that’s out there, what is sort of the pecking order of the easiest cessation product for the consumer?
Linda P. Sarna:
Well, first of all, there is no single best product, it’s the best product for that person. And many smokers will have had experience with different types of products and they may have, they can be exposed to a variety of these things. And again, they’re over-the-counter. The nicotine gum is something that you can do in a social setting.
The nicotine patch is something that is sort of a continuous release over time, people aren’t aware. For some people they like that hand to mouth, so the inhaler that kind of looks like a cigarette is good. The lozenge works for other people. There are lots of choices.
Selma R. Schimmel:
Now I know of some on the oral derivatives that you are able to, and initially still smoke a little bit to begin to wean off but on the over-the-counter ones, I believe, there are warnings that say, ‘do not smoke’.
Linda P. Sarna:
Right, if it says, ‘nicotine replacement’ you need to put out that cigarette.
Selma R. Schimmel:
What happens to the person that will take a drag on a cigarette while they’ve got one of these on?
Linda P. Sarna:
Heart race, blood pressure goes up… you’re getting double nicotine.
Selma R. Schimmel:
Alright, so we talked about the quit line program, what about some of the other ONS-related cessation activities that you’re involved with?
Linda P. Sarna:
Well, another one of our papers at this conference has to do with smoke-free environments. Now, since the mid-nineteen-nineties hospitals have been smoke free, but not the grounds. And now we’re seeing a movement across the United States to really make the grounds smoke-free. Now, the good thing about having any workplace go smoke-free, and the grounds, is it makes it more difficult to smoke, and people quit. It’s annoying, it’s hard to go outside, downstairs, two blocks down, go into your car and take that cigarette. Now if you want it you can still do it but the smoke-free environment really enhances quit efforts. So this is something else that the Oncology Nursing Society, I think, has been very involved in, is looking at tobacco control, not just for all the resources to help smokers quit, but also the smoke-free environment. And then the advocacy efforts in terms of policy are huge as you may know. There are some new packaging that’s going to come out with cigarettes. They’re going to look pretty different next year because they’re going to have ugly pictures of what really happens to your body when you smoke; scary pictures, poignant pictures about loved ones that are affected by smoking.
Selma R. Schimmel:
So, as a take-away message for viewers, say you have a loved one who’s a smoker, say you’re on the fence thinking, ‘you know, I really do need to quit’, what is your take-away message. Give us again the quit line phone number and also the initial things a person can do to make it easier to really commit to life and health.
Linda P. Sarna:
Healthcare providers really can make a difference here. 1-800-QUIT-NOW is the national quit line, available for free for every smoker in the United States. Quitting is tough. It takes several times before you’re able to be smoke-free. The gold-standard, the most effective way is to both have counseling, social support and also use medications as prescribed by the FDA. So any smoker who is trying to seriously think about a quit attempt, good for you. Don’t get discouraged, relapse is part of the quitting process. Tell your family and friends that you’re quitting, clear out your house of tobacco products, discuss with your healthcare provider, your pharmacist about the different medications to see if that will help with nicotine withdrawal, consider calling the quit line or being involved in others, so a type of social support, know that the moment that you quit you’re going to get immediate health benefits cardiovascular and peripheral vascular disease particularly.
Selma R. Schimmel:
Linda, I failed to mention that you come to us from the UCLA School of Nursing where you are professor and Lulu Wolf Hassenplug Endowed Chair. So you have really gone to the highest level that an oncology nurse can go to. You’re both professor and…
Linda P. Sarna:
Well, it’s been my privilege really, to have an impact on the profession, to raise awareness about the issues facing people, patients and family members who are living with lung cancer, and also the power of the individual nurse to make a difference in terms of tobacco control.
Selma R. Schimmel:
Thank you for all the work you’re doing and I hope that the next time we meet you’ll give me really great new stats.
Linda P. Sarna:
Me too.
Selma R. Schimmel:
Okay, great. Thank you.
Linda P. Sarna:
Thanks a lot.
END OF VIDEO