Date of Award

2025

Degree Name

Master of Science (Physiotherapy)

Schools and Centres

Health Sciences

First Supervisor

Shane Patman

Second Supervisor

Caroline Bulsara

Abstract

As smoking is prohibited on most hospital grounds, hospitalisation presents a valuable opportunity for healthcare professionals to identify smokers, administer smoking cessation treatments, and ensure appropriate inpatient support, as well as continued follow-up on discharge. It has been reported both anecdotally and in published research that encouragement from a health professional is a significant external prompt for a smoker to attempt quitting. It has also been noted in the inpatient setting, one in every 33 conversations will lead to the successful cessation of smoking.

More broadly, a 2012 Cochrane review on smoking cessation interventions for inpatients identified that they are effective, regardless of the patient’s admitting diagnosis. This is further supported by a subsequent 2019 publication which found that inpatient smoking cessation programs are highly cost-effective. An updated 2024 Cochrane review further investigated which interventions are effective in assisting hospital inpatients to quit smoking. It identified ongoing support that counselling initiated in hospital and continued for at least one month and the provision of pharmacotherapy improves quit rates, compared to no intervention. Despite the mounting evidence that inpatient smoking cessation interventions (ISCIs), including smoking cessation pathways, can potentially lead to smoking cessation, Western Australia (WA) is yet to develop a statewide policy on and to date the use of an ISCI in a private hospital setting has yet to be explored. It was proposed that an ISCI could be implemented successfully amongst patients within a Western Australian based hospital. Thus, the purpose of this study was to determine if the Queensland Health Smoking Cessation Clinical Pathway (SCCP) was feasible for use at Hollywood Private Hospital (HPH).

This study was conducted in two phases. Firstly, an integrative review was conducted to evaluate the impacts and outcomes on ISCIs on smoking outcomes and quality of life. The second phase involved conducting an embedded mixed methods feasibility study of implementing the Queensland Health SCCP at HPH. Quantitative and qualitative data were collected to assist in determining the feasibility, development and implementation of a smoking cessation clinical pathway at HPH.

The quantitative findings from surveys with regards to the feasibility of the SCCP delivery were overall positive. Recruitment processes as well as data collection and study procedures were well accepted by staff and patients. Patients and staff were overall satisfied with the inpatient and discharge support provided as part of the SCCP. The cost of nicotine replacement therapy (NRT) was found to be manageable by 42.3% of patients on discharge, however, for 38.5% this was not applicable as they discontinued NRT use on discharge. Results demonstrated a quit rate of 42.3% at 4-6 weeks and 41% at 12 months following discharge from hospital. Patients who were not successful with their smoking cessation were overall still satisfied with the support they received from participating in the SCCP. The qualitative findings for both patients and staff were also largely positive and a number of facilitators and barriers to the delivery of the SCCP were identified. Overall, the results presented indicate that the SCCP is potentially feasible and well accepted by patients and staff regardless of smoking cessation success. Findings from this research have assisted in the development of an ISCI at HPH that is well accepted by patients and staff and improves smoking related outcomes.

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