Electronic Cigarettes and Smoking Cessation in the Perioperative Period of Cardiothoracic Surgery: Views of Australian Clinicians
Abstract
:1. Introduction
2. Methods
2.1. Design and Data Collection
2.2. Data Analysis
3. Results
3.1. Electronic Cigarettes Were Unlikely to Be Safe but Still Safer than Tobacco Cigarettes
“What have I picked up? From a medical point of view? Nowhere. This is from a media point of view—it’s a nicotine replacement, so it deals with cravings.” (S12)
“It’s going to take years to get a handle on whether they are better or worse. Maybe it will cause other things we don’t even know about.” (S1)
“You can get NRT on a prescription, and over the counter. That could work for electronic cigarettes too.” (A6)
3.2. Electronic Cigarettes May Have a Harm Reduction Role in the Context of Public Health
“Electronic cigarettes are nicotine and flavour. Even if the flavour is poisonous, it’s probably better than 3000 other chemicals in a tobacco cigarette.” (A5)
“Electronic cigarettes still promote the oral component, so it would be too easy to slip back to smoking. And their use suggests that it’s still socially acceptable to put them in your mouth, renormalising smoking again.” (S11)
“I think people want to stop smoking. There’s those who can do it cold turkey or with nicotine replacement, but some need the hand-to-mouth kind of behaviour to continue. Whichever gets them off the cigarette.” (S6)
3.3. Electronic Cigarettes Were a Potential Smoking Cessation Tool for the Extraordinary Circumstances of Surgery
“I see so many patients who they stop from 60 a day to nil just by not relenting. That’s probably part of the reason, maybe the motivation and the mental attitude to that. So, if they want to do it, they can do it without the electronic cigarette.” (S15)
“I have concerns about the flavours, because you don’t know what’s in it. They’re inhaling a whole cocktail of things before the anaesthetic.” (A4)
“If using electronic cigarettes was a way of getting higher concentrations of nicotine as a single hit, which some people seem to need, that would be worthwhile, because other means of nicotine therapy are delivered too slow, compared to tobacco cigarettes.” (A12)
“I think there are patients who are so habituated to smoking that if electronic cigarette use is the only way they can stop, I accept that.” (S10)
3.4. Patient-Clinician Discussions Were Influenced by Clinician Views about Electronic Cigarettes and Clinicians’ Professional Role
“I would tell the patient that it’s good that they’re showing steps to try and stop smoking, but they would need to talk to their surgeon about electronic cigarettes. They’re not harmless.” (P5)
“I would talk to the surgeons and ask what their opinion was. I would have to get more information because I wouldn’t want to recommend something that I know nothing about.” (N9)
“You have to use whatever means are appropriate to protect the patient from themselves and to optimise their surgical outcome in the short term and their life outcome in the long term.” (S14)
“I would be comfortable recommending an electronic cigarette because I think it achieves the outcome that we want for the patient.” (A14)
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Characteristic | Surgeons | Anaesthetists | Nurses | Physiotherapists |
---|---|---|---|---|
Gender (male), n (%) | 15 (100%) | 13 (87%) | 1 (9%) | 1 (9%) |
Age (year), n (%) | ||||
<40 | 5 (45%) | |||
>40 | 15 (100%) | 15 (100%) | 11 (100%) | 6 (55%) |
Current work setting, n (%) | ||||
Public hospital | 15 (100%) | 15 (100%) | 8 (73%) | 5 (45%) |
Self-reported time working in cardiothoracic surgical area (year), n (%) | ||||
<10 | 2 (13%) | 11 (73%) | 4 (36%) | 7 (64%) |
>10 | 13 (87%) | 4 (27%) | 7 (64%) | 4 (36%) |
Theme | Sub Theme | Categories | Professions and Frequency | |||
---|---|---|---|---|---|---|
Anaesthetists (n = 15) | Surgeons (n = 15) | Nurses (n = 11) | Physiotherapists (n = 11) | |||
Electronic cigarettes were unlikely to be safe but still safer than tobacco cigarettes | Limited knowledge of electronic cigarettes | Media was the main source of information | 15 | 15 | 11 | 11 |
Electronic cigarettes should be banned or regulated until further evidence available | 2 | 5 | 3 | 0 | ||
Unsure of how electronic cigarettes should be regulated due to lack of evidence | 10 | 9 | 8 | 11 | ||
Electronic cigarettes should be available over-the-counter/tobacconist | 2 | 1 | 0 | 0 | ||
Electronic cigarettes may have a harm reduction role in the context of public health | Positive views of electronic cigarettes | Electronic cigarettes as the lesser of two evils | 8 | 7 | 4 | 6 |
Hand to mouth similarities as an alternative form of nicotine replacement therapy (NRT) | 4 | 5 | 2 | 2 | ||
Negative views of electronic cigarettes | Electronic cigarettes were too similar to tobacco cigarettes | 3 | 3 | 5 | 3 | |
Electronic cigarettes were a potential smoking cessation tool for the extraordinary circumstances of surgery | Electronic cigarettes as an alternative to tobacco smoking | If patients had tried other methods and were unable to quit | 5 | 4 | 3 | 4 |
As a bridge off tobacco smoking before surgery | 4 | 6 | 2 | 2 | ||
Clinicians’ preferred methods outweighed potential role of electronic cigarettes | Preference for evidence-based methods of NRT | 2 | 2 | 5 | 1 | |
No nicotine in any form allowed for their patients prior to surgery | 1 | 2 | 1 | 0 | ||
Unknown effects of vaping on patients’ airways | 3 | 1 | 0 | 4 | ||
Patient-clinician discussions were influenced by clinician views about electronic cigarettes and clinicians’ professional role | Consider patient short-term use of electronic cigarettes before surgery | Comfortable with discussing electronic cigarette short-term patient use to help stop tobacco smoking prior to surgery | 8 | 7 | 1 | 2 |
Discourage patient use of electronic cigarettes | Comfortable with discussing the lack of evidence being their reason for not recommending electronic cigarettes | 1 | 4 | 2 | 1 | |
Unsure and would seek advice | Emphasis on patient’s choice to use electronic cigarettes due to lack of own knowledge | 6 | 4 | 8 | 8 |
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Share and Cite
Luxton, N.A.; Shih, P.; Rahman, M.A. Electronic Cigarettes and Smoking Cessation in the Perioperative Period of Cardiothoracic Surgery: Views of Australian Clinicians. Int. J. Environ. Res. Public Health 2018, 15, 2481. https://doi.org/10.3390/ijerph15112481
Luxton NA, Shih P, Rahman MA. Electronic Cigarettes and Smoking Cessation in the Perioperative Period of Cardiothoracic Surgery: Views of Australian Clinicians. International Journal of Environmental Research and Public Health. 2018; 15(11):2481. https://doi.org/10.3390/ijerph15112481
Chicago/Turabian StyleLuxton, Nia A., Patti Shih, and Muhammad Aziz Rahman. 2018. "Electronic Cigarettes and Smoking Cessation in the Perioperative Period of Cardiothoracic Surgery: Views of Australian Clinicians" International Journal of Environmental Research and Public Health 15, no. 11: 2481. https://doi.org/10.3390/ijerph15112481