Patient experience of smoking lapse and relapse back to smoking Dr Caitlin Notley SSA Research Fellow, Norwich Medical School, University of East Anglia Faculty of Medicine and Health Science Norwich Medical School
Background • NHS Stop Smoking services are effective and costeffective (West et al, 2013), but relapse is common (Ferguson, 2005) • Insufficient evidence for any specific RP intervention (Hajek et al, Cochrane review, 2009, Agboola et al, 2010) • Current smoking cessation guidelines do not recommend any specific interventions for smoking relapse prevention (NICE, 2008) Faculty of Medicine and Health Science Norwich Medical School
A Randomised Controlled Trial of Selfhelp Materials for the Prevention of Smoking Relapse (09/91/36) Investigators: Project coordinators: Collaborators: 1. 2. 3. 4. 5. 6. 7. 8. F Song (PI)1, R Holland 1, G Barton 1, M Bachman 1, P Aveyard 2, S Sutton 3, J Leonardi-Bee 4, T Brandon 5 V Maskrey 1, A Blyth 1 M Adeney 6, K Mc. Goldrick 6, T Dyer 7, C Slater 8 Norwich Medical School, University of East Anglia, UK Nuffield Department of Primary Care Health Sciences, University of Oxford, UK Institute of Public Health, University of Cambridge, UK Epidemiology and Public Health, University of Nottingham, UK Tobacco Research and Intervention Program, University of South Florida, USA Smoke. Free Norfolk, Norfolk Community Health and Care Trust Norwich CRTU NHS Norfolk Stop Smoking Services Faculty of Medicine and Health Science Acknowledgement: ‘This project was funded by the NIHR Health Technology Assessment programme and will be published in full in the Health Technology Assessment journal series. Visit the HTA programme website for more details www. hta. ac. uk/link to project page. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Department of Health’ ref: 09/91/36 Norwich Medical School
Smoking lapse and relapse • The Sharpish trial: “Following the Russell Standard, the primary outcome was prolonged abstinence from months four to 12, with no more than five cigarettes in total, and confirmed by CO<10 ppm at the 12 month follow-up” • Therefore relapse = more than five cigarettes in months 4 -12 of the study • Following this, lapse = less than 5 cigarettes within the last year. Faculty of Medicine and Health Science Norwich Medical School
Previous studies of smoking lapse and relapse • Primarily quantitative – identification of relapse ‘triggers’ and high risk situations, e. g. being around smokers, stress (Brandon, 1986, Piasecki, 2006) • Psychological factors – cue reactivity, attentional bias (Powell et al, 2010) • Association between level of dependence and likelihood of relapse (Powell et al, 2010) • Response: Focus on coping skills (ineffective coping in response to high risk situations → relapse) (Marlatt 1980, Marlatt & George, 1984; Song, 2009) Faculty of Medicine and Health Science Norwich Medical School
SHARPISH Q • 43 In depth qualitative interviews • Purposive sampling across trial sample Smoking status Intervention group Intervention control abstinent 15 11 relapsed 8 9 • Sample was representative of the study population as a whole • Focus groups with participants and SS professionals • Grounded theory approach to analysis. 10% coding independent verification Faculty of Medicine and Health Science Norwich Medical School
Findings • 874/1404 (62%) trial participants relapsed at 12 months (530/1404) CO verified abstinence) • 17/43 (40%) qualitative sample self reported relapse • 23 ‘lapse narratives’ (within last 12 months) Faculty of Medicine and Health Science Norwich Medical School
Findings – the process of a smoking lapse Mood Social Prior to lapse Identity Cognitive Motivation Situational Lapse triggers Brief lapse only – no relapse (4) Psychological Environmental cue rationalising Outlook following lapse Lapse leading to relapse Lapse slowly leads to relapse (2) Faculty of Medicine and Health Science Lapse quickly leads to relapse (7) reflection feelings Norwich Medical School
From lapse to relapse 1. Unplanned lapse ‘before I knew it I was smoking again’ ‘I don’t know what I was thinking’ ‘that was it’ ‘I was drunk’ ‘so we were going fishing and I went to [supermarket] as it happens on the er Thursday prior to going fishing, to get some bits and pieces of food for, for going, and I went up to the tobacco kiosk to buy a lottery ticket …And er- the woman in front of me, she bought some cigarettes and (coughs), God knows what made me do it, I just- I said if you can- do us some lucky dips on that one please, oh and I said, while I’m at it, I’ll have half an ounce of one of your(0677, male, age 75, Relapsed)
From lapse to relapse 1. Planned lapse, unplanned relapse ‘I thought I could just have one’ ‘I was on holiday’ well it was kind of outdoors like a club every night for the kids…and then the adults will stay there you know…and people were smoking around and then I was really, really craving a cigarette and I couldn’t get ? ? . . . and then the next day I found a cigarette machine in the hotel …and I bought some but I didn’t buy any to take back with me I didn’t plan to smoke when I came back…but I did (0940, female, aged 56. Relapsed but abstinent again at follow up) Faculty of Medicine and Health Science Norwich Medical School
From lapse to relapse 2. Planned lapse, and relapse ‘I couldn’t cope’ ‘what the hell’ ‘things can’t get any worse’ Faculty of Medicine and Health Science I had to walk away from the situation, my parents, and I had to say no, and it was a case of I, that’s what I’m going to do and I drove five miles, even on the way there I thought to myself why am I doing this, and it was a case of something in my brain was saying I want one (0674, female, age 49, relapsed. ) Norwich Medical School
From lapse to abstinence 3. Unplanned lapse, avoidance of full relapse ‘I thought it would help, but it didn’t’ ‘I don’t need it anymore’ ‘I used my e cigarette instead’ ‘and my partner and I had a bit of a to-do argument or whatever…and we were at the pub at the time…so I just asked someone I knew for a couple of ciggy’s so I did have a bit of a but I knew the next day I would go straight to not having any…because as I suspected the cigarettes didn’t really do anything at all’ (0818, female, age 37, abstinent) Faculty of Medicine and Health Science ‘that was it… although everyone thought that I was going to go back to cigarettes, right on top of Christmas, cos we moved, and I didn’t… and they were all shocked that I didn’t because, you know ‘(NAME) has a crisis (NAME) immediately goes for a cigarette’, that’s what they assumed would happen, and it was just those two times (0728, female, age 49, abstinent) Norwich Medical School
The process of a smoking lapse – Sharpish-Q Analysis and the RP model Expectations / anticipation Mood rationalising Identity Mood 2 groups: Planned vs. unplanned relapsers Lapse triggers: • • • Environmental Social Psychological Identity Socio-cultural Feelings/ reflection Physical effects Psychological, social, cultural and identity related factors for describing the move to relapse
Conclusions • In-depth understanding of patient experience of smoking lapse/relapse • Lapsing and/or relapsing back to smoking is a complex process rather than a discrete event • The concept of identity appears to be important for describing the move to relapse • Possible adaption of our current theoretical understanding of relapse to incorporate instances of planned relapse, and lapse situations where relapse is avoided. • Importance of addressing the concept of identity within smoking relapse prevention interventions for future testing. Faculty of Medicine and Health Science Norwich Medical School
References Hajek P, Stead LF, West R, Jarvis M, Lancaster T. Relapse prevention interventions for smoking cessation. Cochrane database of systematic reviews (Online) 2009(1): CD 003999 NICE public health guidance -Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities. NICE public health guidance 10. National Institute for Health and Clinical Excellence; 2008. Piasecki, T. M. (2006) Relapse to Smoking, Clinical Psychology Review, 26: 2 , March 2006, p 196– 215 Marlatt GA, Gordon JR: Determinants of relapse: implications for the maintenance of behavior change. In: Behavioral medicine: changing health lifestyles. edn. Edited by Davidson P, Davidson S. New York: Brunner/Mazel; 1980: 410 -452. Song F, Huttunen-Lenz M, Holland R. Effectiveness of complex psycho-educational interventions for smoking relapse prevention: an exploratory meta-analysis. Journal of Public Health 2009, doi: 10. 1093/pubmed/fdp 109. Agboola S, Mc. Neill A, Coleman T, Leonardi Bee J. A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers. Addiction 2010, 105(8): 1362 -1380. West R, May S, West M, Croghan E, Mc. Ewen A. Performance of English stop smoking services in first 10 years: analysis of service monitoring data. BMJ 2013, 347: f 4921. Ferguson J, Bauld L, Chesterman J, Judge K. The English smoking treatment services: one-year outcomes. Addiction 2005, 100 Suppl 2: 59 -69. Brandon, Thomas H. , Stephen T. Tiffany, and Timothy B. Baker. "The process of smoking relapse. " Relapse and recovery in drug abuse 72 (1986): 104. Marlatt, G. A. & George, W. H Relapse prevention: Introduction and Overview of the Model. British Journal of Addiction, 79 (1984): 261 -273 Marlatt, G. A. & Gordon, J. R 1985 Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. Guilford Press
We’ve come a long way. . .
Скачать презентацию Patient experience of smoking lapse and relapse back
6e3a83695fdc74a2ffcacab56ebcf320.ppt