Study Aim
The National Institute for Health and Care Excellence’s (2013) guidance on smoking cessation in acute services indicates healthcare professionals have a duty to provide people with support to stop smoking. However there is a lack of evidence on how this is best achieved in practice. This implementation study sought to determine what works to support brief smoking cessation (BSC) in acute hospital settings, through exploration of organisational delivery and the role of healthcare professionals.
Methods
The study utilised a realist approach with embedded stakeholder engagement to develop an initial programme theory with three provisional theory areas: organisational consistency, the healthcare professionals’ role and the window of opportunity. A realist synthesis of the evidence resulted in contingent context mechanism outcomes configurations (CMOs) on these theory areas. These CMOs were then interrogated within a Health Board through a mixed methods approach, using interviews (n=27), a survey (n=279) and a review of Health Board documentation (n=44). This culminated in final CMO configurations and a programme theory to explain how BSC implementation in acute hospital settings can be supported.
Findings
Healthcare professionals implement BSC when they value it as an important part of their role in contributing to improved patient outcomes; this is due to personal and professional influences, such as knowledge or experience. Organisational support, training and working in an environment where BSC is visible as standard care, positively influences implementation. However, the context exerts a strong influence on whether BSC is implemented or not. Healthcare professionals make nuanced judgements on whether to implement BSC based on their assessment of the patient’s responses, the patient’s condition and other acute care demands. Healthcare professionals are less likely to implement BSC in dynamic and uncertain environments, as they are concerned about adversely impacting on the clinician-patient relationship and prioritise other acute care requirements.
Conclusions
Organisations should actively promote BSC as a core function of the acute hospital setting and improve professional practice through leadership, training, feedback and visible indicators of organisational commitment. Healthcare professionals can be persuaded that implementing BSC is an acute care priority and an expectation of standard practice for improving patient outcomes.