Congress Abstracts 2004

93

THE ROLE OF THE NURSE IN IMPROVING ASSESSMENT AND DOCUMENTATION OF TOBACCO USE IN PATIENTS WITH LUNG CANCER. Dana Inzeo, RN, MA, AOCN^®, and Pamela Ginex, RN, MPH, OCN^®, Memorial Sloan Kettering Cancer Center, New York, NY.

Over 90% of lung cancers are attributed to smoking and/or tobacco use. Many patients diagnosed with lung cancer are actively using tobacco. Research has shown that patients with lung cancer who quit smoking can increase their life expectancy and decrease both treatment complications and risks for a secondary malignancy (Cooley, 2002). Results of a meta-analysis by the Agency for Health Care Policy and Research (AHCPR) (1995) showed that having a system for assessing and documenting tobacco use both doubled the rate in which clinicians were advising patients about cessation, and the rate of actual patient cessation.

The purpose of this project is to improve assessment and documentation of tobacco use with a projected affect on improving and maintaining the smoking cessation rate among patients with lung cancer. According to the AHCPR guidelines, there are five A’s essential for an effective smoking cessation plan: Asking about smoking, advising to quit, assisting to stop, assessing readiness for change, and arranging for follow-up. In a retrospective three-month review at an NCI-designated comprehensive cancer center, 575 patients with newly-diagnosed thoracic cancer were seen. Of the 157 medical patients treated, 35% were active smokers. Of the 137 surgical patients who had surgery, 33% were active smokers. These statistics reflect an opportunity for nurses to provide consistent assessments at every clinic visit in order to encourage smoking cessation.

The nurses from the ambulatory thoracic oncology practice at this cancer center have incorporated a tobacco-use section into their routine patient assessment tool. This addition serves as a prompt to the nurse to actively ask and document tobacco use.

By standardizing assessment and documentation of tobacco use according to the AHCPR outcome recommendations, the authors hope to reduce tobacco use in ambulatory patients with lung cancer. This presentation will include the documentation tool and an evaluation of the rate of compliance in using the tool.

Use of this assessment tool will prompt these oncology nurses to ask about and become more comfortable with dialoging with patients about tobacco use. Increased attention to tobacco use will decrease patients’ tobacco use.