Project will explore whether brief intervention in emergency departments increases smoking cessation rates among those admitted with chest pain
Getting a person to commit to breaking a nasty habit may best be accomplished when that person is in physical pain and possibly frightened.
Such is the basis for a four-year $2.1-million grant from the National Institutes of Health (NIH) to study the effectiveness of smoking-cessation counseling provided to patients who arrive at two local hospitals with chest pain, and who are admitted for observation. These individuals are usually at low risk for heart attack but are kept under scrutiny for 24 hours while blood tests are taken.
"The patients are basically sitting and waiting for the next test, and there is a lot of down time," said Beth Bock, assistant professor of psychiatry and human behavior. "We have the chance in these situations to work with a captive audience."
Bock began the work earlier this year at Rhode Island Hospital, using a three-year grant from the American Heart Association (AHA). The NIH funds will allow Bock to continue the work for the next four years and expand the study to The Miriam Hospital. She will return the remaining two years of the AHA grant by Dec. 31.
The project's bottom line is to find whether a brief intervention in the observation unit of the emergency department actually increases smoking cessation rates among those admitted with chest pain symptoms, and by how much. Nine out of ten times, a person admitted to the hospital for chest pains will not have suffered a heart attack, but still must be kept for observation.
In other studies, spontaneous quit rates as high as 60 percent have been reported for hospitalized heart attack victims. The rate of on-the-spot quitting in the physician's office during routine visits is about 3 percent.
"We don't know what happens if people have had a scare without suffering a lingering illness," Bock said. "By intervening with patients who are admitted with symptoms of chest pain, we are approaching smokers at an opportune `teachable' moment, when they may be more likely to consider smoking cessation."
In the study, patients will receive either the usual care for chest pains, or enhanced care, which includes advice directly from a physician to quit smoking, a single counseling session with a trained health educator, nicotine replacement in the form of a nicotine patch and telephone follow-up calls.
The 30- to 45-minute counseling session will take place while the patient is in the observation unit. The nicotine patch will be offered to patients who choose to quit and who obtain the attending physician's approval.
"The intervention is gentle and nonjudgmental," said Bock, who is based in the Brown University Center for Behavioral and Preventive Medicine at The Miriam Hospital. "These patients are under a lot of stress as it is. We talk with them about what they are thinking about smoking, their thoughts about quitting and their other concerns."
The researchers will assess the smoking status of patients at one, three and six months after recruitment for the study. Smoking abstinence will be considered seven or more consecutive days without smoking.
Bock is conducting several projects designed to find the teachable moment to help smokers kick the habit. Studies show that the more intensive the treatment, the higher the quit rates.
"It's `the more the better' when it comes to treatment," she said. "In this study, we've added the patch, the individual counseling and follow-up calls. This is not an overly burdensome intervention. We want to see how much we can reasonably deliver in this setting and still make a significant difference."
Bock calls the emergency department an "underutilized setting" for use of smoking-cessation counseling. She recently applied for NIH funding to conduct a similar intervention for smokers admitted to the emergency department with respiratory problems.
"This is all part of an ongoing exploration of teachable moments," she said. "We're trying to find which moments are really teachable and who is truly teachable."