How accepting of smoking cessation support are the remaining hospital patients who smoke?

Background

Ireland has strong smoking prevention policies and good support to cease over decades. However there remains a hard core of persistent smokers. Hospital admission/attendance should provide a cue to action. The aim of this study was to determine trends in the acceptance of smoking cessation supports in inpatients and outpatients in a large specialist cancer, tertiary referral hospital in Dublin.

Methods

Using the hospital smoking cessation database, trends in key smoking cessation measures (setting a quit date (SQD), agreeing to smoking cessation and accepting a referral to smoking cessation service (SCS)) in 2017-2023.

Results

Clinical teams referred 1321 inpatients to SCS (with patient agreement); numbers fell from 257 in 2017 to 191 in 2022 and 182 in 2023. There was a fluctuating but significant downward trend in SQD, from 64% in 2019 to 48% in 2023 (p < 0.001). Agreement to referral to SCS fell from 51.8% in 2017 to 31.3% in 2023 (p < 0.001). Smoking ≥20 cigarettes per day fell (41% in 2017 to 22.4% in 2023 (p < 0.001)). Results were similar by sex. 1440 outpatients were seen, with an increase from 103 to 295 annually. However, the proportion agreeing to any one of 3 key measures (set an immediate quit date, accept smoking cessation or SCS) fell from 75% (2017) to 58% (2022) and 65% (2023). 454 (31.5%) outpatients declined follow up, ranging from 33.1% to 48.6%, highest during COVID-19 years 2020-2022. Overall men were more likely to set a quit date (16.3% vs 11.3%; p = 0.005), however women were more likely to agree to smoking cessation (11% vs 7.6%; p < 0.05) and accept SCS referral (71.7% vs 65.3%;p<0.01).

Conclusions

Our findings show a decline in key early measures of interest in smoking cessation in patients, but a reduction in heavy smoking. Men set quit dates but are less likely to accept longer term intervention, matching an increase in male smoking seen since 2020 in Ireland. The findings suggest a need to reinvigorate smoking cessation policies.

Key messages

• Patients who are smokers show reducing interest in smoking cessation.

• Findings suggest reinvigoration of smoking policies are needed if tobacco-free society is to be achieved.