Smoking cessation in the Czech Republic
Linda Sarna – University of California Los Angeles, USA
Can you tell us about your presentation?
We know that tobacco is the leading cause of death, preventable death, in the world and it’s a major cause of many, many cancers. For example, in the Czech Republic it’s attributed to a quarter, one out of four, of all cancers. We can do a lot by preventing tobacco use but we can also change that number by helping people quit. In the Czech Republic over a third of adults smoke and smoking, unfortunately, among young women is higher than among young men so we have a new population who are going to continue to smoke. The evidence is very good that nurses can use evidence-based strategies, meaning providing social support, information about medications to decrease withdrawal, that will be effective in helping patients quit. Unfortunately these recommendations are not often implemented in the clinical setting and even after a diagnosis of cancer, quitting smoking is important because it impacts treatment, it impacts survival, it impacts symptom management and quality of life too. So we wanted to make certain that the nurses in the Czech Republic had the information that they needed to feel comfortable in their day-to-day clinical practice to both assess and intervene with people who smoke.
What is the content of the training and how is it being delivered?
One aspect that’s unique about this particular programme is it wasn’t just a group of Americans coming, giving a lecture, having it translated. We collaborated with the physicians in the Czech Republic, Dr Eva Kralikova and Dr Alexandra Kmetova, and four nurse champions, four nurses who were also expert in tobacco control. These nurses are currently working in the over thirty tobacco dependence treatment centres throughout the Czech Republic. Their experience is giving very long, intensive workshops, we wanted to develop a model that was very brief that could be delivered within an hour in a clinical setting so that every nurse would have a minimum expertise in tobacco control. They wouldn’t be experts but they would know, for example, how to refer smokers to a telephone quit line which is active in the Czech Republic which is a very effective way to provide smokers with support. So last year we did a pilot workshop, we collaborated on a curriculum from epidemiology of tobacco use, health effects, understanding nicotine addiction, looking at evidence-based strategies for helping people quit and then also how to integrate, how to translate these findings into practice. We learned from that workshop that the nurses really wanted to do more role-playing and so then when we did our workshop a couple of days ago with over 22 nurses from around the Czech Republic, we included all of those aspects. We also have had things in Czech translated to English and translated back into Czech so our translators, who have really been Eva and Alexandra, have been pivotal. But we’ve also had a cultural understanding of what’s important for these nurses and ways that the delivery made sense.
Have you had any feedback from the workshops so far?
Very positive. So what will happen is we want to have multipliers, so the nurses who attended our workshops will now go to their own institution and they have a commitment to train at least 10-20 other nurses. So you can imagine how we’re hoping to change this culture. What we will do is there will be an assessment of the nurses in the hospital setting before they get the workshop from the trainers and then three months later. We want to focus not just on what the nurses have learned but how it has changed their practice. So our questionnaire will be how it changes their frequency of interventions with patients with the types of information and support that they deliver. So we’re going to have to wait a few months before we’re able to totally evaluate the efficacy. But we’ve had experience in the United States where this has been very successful and also we have a large project in China right now, too.
What are your plans for the future?
Because of our successful collaboration in the Czech Republic, we were able to apply for funding for the Bristol Myers Squibb Foundation for two more years of funding. Now we’re going to include our collaborators in Poland, so I’ll be working with nurses and physicians in Poland and in the Czech Republic to do more distance learning types of educational strategies. I think one of the things I also wanted to mention that is important is when we look at barriers for changing nursing practice, there are several of them. One is lack of nursing leadership and that is changing, clearly, in the Czech Republic with these nurse champions. The other is the lack of education and skills, this is the type of information that, unfortunately, is not often in a lot of health science curricula, not just nursing curriculum. The third important area is smoking among healthcare professionals and in the Czech Republic over 40% of the nurses smoke. Tobacco addiction is a very, very powerful addiction, it’s really tough to quit, we need to really provide all the support that we can to help the nurses change their own behaviour because it’s not just a personal issue it also impacts their interventions with patients. So that’s something that’s a little bit different here in the Czech Republic and it will also be our challenge in Poland.