Patient Teaching Plan: Smoking Cessation

The number of cancer diagnoses is on the rise. Every year, more people come to find that they have this disease and must decide between several life-altering treatments in order to prolong their lives, sometimes at the cost of their overall quality of life. Lung cancer is quickly becoming one of the more frequently seen cancer diagnoses. According to the Centers for Disease Control and Prevention (CDC) over 200,000 new cases of lung cancer were reported in 2015 alone and over 150,000 deaths due to complications from it (2017).

Although its prevalence is on the rise, lung cancer is also one of the most preventable forms of the disease simply by abstaining from smoking from tobacco products. However, all hope is not lost for those who do smoke. By completing a smoking cessation program, patients can see an increase of their health overall, as well as significantly reduce their risk of developing lung cancer.

Preventable Disease Overview

Cancer is a disease involving the replication of malignant cells that do not function in the same manner as the body’s normal cells and grow uncontrollably.

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Lung cancer is a disease where malignant cells originate within the lungs (National Cancer Institute, 2017). There are two types of lung cancer, small cell and non-small cell which are commonly differentiated by their cell structure after microscopic examination. Small cell lung cancer is identified by the small oval shape of its cells and is more aggressive in nature whereas non-small cell lung cancer is more common overall.. Despite these differences, they both share a major common risk factor: tobacco use (National Cancer institute, 2018a, 2018b).

Lung cancer is typically diagnosed by imaging studies such as chest x-ray and computed tomography (CT) scan. These allow the lungs to be visualized to see if there are any potential abnormalities. Sputum samples can also be collected to determine if malignant cells are present (National Cancer Institute, 2017). However, the presenting symptoms of lung cancer are not specific to the disease process itself. They can often be confused as ailments mimicking that of the common cold or a respiratory infection. Coughing that becomes progressively worse, chest pain, being short of breath, wheezing, hemoptysis, diminished lung sounds, tachycardia, and general malaise with possible unexplained weight loss. Diagnosis can also be further complicated because these symptoms often do not become apparent until the cancer is in its later stages (Centers for Disease Control and Prevention, 2018). Should bloodwork or sputum samples come back with inconclusive results, bloodwork can be obtained to look for tumor-markers to help guide a diagnosis.

After conducting a family genetic history as well as a general health history, the highest risk factor shared between patients was their tobacco use. The patients involved had admitted to smoking for a relatively long amount of time, but have been unsuccessful in quitting. This becomes even more concerning as the patients also reported having a family history of cancer, which already puts them at an increased risk for developing the disease. Based on patient responses, psychological stressors such as family and financial hardships and emotional impairment also played a large role in the decision to begin smoking.

Evidence Based Intervention

While there are pharmacological alternatives on the market such as nicotine replacement therapy, these types of interventions are not always enough to ensure compliance with smoking cessation. Creating support systems both in the home environment as well as by establishing a positive rapport with patients in the clinical setting can greatly increase their chances of success. According to Gilbert Cabrera, there are many actions medical professionals can take to increase their rate of success with quitting smoking. Working with patients to schedule follow up visits and allowing for follow up phone calls can give them a sense of support (2017). Wanting to see patients again as well as checking in on them can help them view staff in a more positive light making it easier for them to discuss other aspects of their health. Agreeing on particular days and times to call can also give patients the feeling of being more in control of their situation overall. Working with the patient to set goals is key to their success. Setting goals that are achievable short-term will help provide the confidence to follow through for long-term goals. An achievable short-term goal would be for the patient to make a list of friends or family who are willing to help them with the quitting process and who will be easily reachable for when they have urges to smoke. A long-term goal to set could be the patient being able to control urges to return to smoking independently. Another possible long-term goal would be to chronicle or journal their journey as it allows them to reflect on their successes and take accountability for when they were unable to follow through with their plans.

Implementation: Teaching Plan

The ultimate goal for the patient would be to stop smoking entirely and overcome the emotional and psychosocial stressors leading them to return to the habit. When devising a teaching plan, it is imperative to ensure that the patient has an understanding of what they will experience with the quitting process. Being up front with what feelings they may experience may seem counterintuitive as it could possibly scare them away, but not addressing it until after the fact can lead to the patient becoming mistrustful of the healthcare team. Smoking cessation can be a very difficult time for patients, and sometimes their support systems are not always readily available. However, there are government funded programs that can assist them. In Pennsylvania, the state department of health has various outlets for patients to help them in their journey to stop smoking. If the patient has internet access, there is a website that has links to free services they can sign up for, twenty-four hour call in lines to provide support in stressful times (Pennsylvania Department of Health, 2018). For patients without internet access, printed materials can also provide useful visuals and reminders. Discussing the long-term effects of overall improvement of health as well as improved emotional well-being can also help remind patients of their overall goal.

Evaluation

At follow up office visits, there would be some changes to expect should the patient have success in quitting. When auscultating lungs during an assessment, they would begin to sound clearer the longer a patient can go without smoking and the patient would report decreased instances of shortness of breath and improving or eliminated cough. Patients should also discuss improving emotional status and decreased desire for tobacco products if they have had success in quitting. When taking vital signs, patients would have well maintained oxygen saturation, as well as a stable blood pressure and pulse. If there were signs that the plan was unsuccessful, it would be imperative to discuss why it did not work with the patient and to do so in an objective and nonjudgmental manner. Quitting smoking can be a very difficult process for some patients, and not all plans work for everyone. Making time for open discussion would allow for the patient to communicate what was successful for them, and then a plan could be revised to focus on similar strategies to what did work while simultaneously helping avoid strategies that made the process more difficult for them.

Summary

Although lung cancer diagnoses are on the rise, patients can still take action to help prevent this in their lives. The risk for lung cancer can by greatly reduced simply by abstaining from or quitting tobacco products. While there are pharmacological interventions available, quitting can still be difficult for patients because in some cases, smoking was an outlet for them to relieve stress. By ensuring patients have support systems in place, be it family, friends, or even state quit-lines and by establishing a positive rapport with the patient during their health visits, they can better manage what could potentially be a very difficult time in their lives.