Faced with a patient who has had a cancer diagnosis, who smokes but rejects any attempt to discuss stopping smoking, what should a stop smoking advisor do?
This is a situation that one of our experienced stop smoking specialist advisors deals with every week. Running a clinic at Glenfield Hospital, a tertiary centre for respiratory conditions, she works closely with Dr Sanjay Agrawal, the British Thoracic Society Stop Smoking Champion for University Hospitals of Leicester. Dr Agrawal, unlike many clinicians, doesn’t subscribe to the theory that straight after a cancer diagnosis is the wrong time to ask patients about stopping smoking. He says ‘There can’t be a better time, given the urgency to do everything possible for a hopeful outcome. Stopping smoking appears to be equally effective as chemotherapy in terms of improving a patient’s prognosis.’
Many patients will have tried, with or without support, to stop smoking, and may fear that it’s too late, or too hard. The advisor talks to them sensitively, and takes time to demonstrate the insight she has into how frightened and perplexed they will be. Some will gladly accept both the behavioural support she offers, along with the traditional licensed stop-smoking medication available to support them during the quitting process.
However, some will have tried all these before, and yet they are still smoking. She asks all her patients now if they have thought about using an e-cigarette. We know from 2 years of clinical experience that people who smoke do rather well when they switch to vaping, and the success rates overall jump an extra 20% once e-cigarettes are included in the quitting process. She fills in the gaps in their knowledge. For example, they may have tried a poor quality cigalike, and she will explain the benefits of more advanced models.
A patient recently told her ‘I wouldn’t touch one of those things with a bargepole!’ At the end of the session, he walked out with a free sample in his hand. His wife was in tears with relief.
This brings me to the point of this blog: why would we not give out free samples to smokers who are teetering on the edge of vaping, but can’t bring themselves to take that leap?
There are many reasons why someone who needs to stop smoking might be reluctant to pay out £30 for a starter kit. They may have been scared off by all the negative publicity, as this patient was. They may not be able to risk wasting that kind of outlay, when money is really tight. They may be confused about the choices, or may have been put off by the technical complexities of e-cigarette use.
Our Stop service gives free samples out. At first we only gave them to people who were so desperately poor that they couldn’t afford to buy one themselves. As our confidence has grown though, we have steadily widened the circle of service users we offer them to, knowing that an introductory device could be the moment someone switches for good from smoked tobacco.
We tell people this is NOT a medicine, it’s just a free sample to give them a sense of what vaping could do for them. We emphasise that they don’t have to accept one, and that we don’t give them to everyone, we just happen to have some at the moment.
Financially, at less than the cost of a single pack of NRT, it only represents a small outlay for the service, and if someone choses to vape instead of using nicotine replacement therapy, there are further savings made for the remainder of their treatment because they will buy their own vaporiser and liquid. Some will continue to get additional NRT from the service, but probably less than they would have used if they hadn’t also been vaping.
From a risk point of view, we know that vaping is at least 95% safer than smoking. Anyone using a free sample vaporiser will immediately reduce their risk, and those who continue to buy their own supply will reduce the risk even further. We give advice about safe charging and keeping the device and liquids away from children and pets.
What brand to buy? Some services have agonised about this, fearing that choosing one brand over another will leave them open to criticism. We have found that pre-filled units are readily accepted by our service users, and we got ours from Totally Wicked. However, we tell our service users about all the specialist shops in the city, and leave them to make their own choice.
Is this too bold? Are we courting disaster? Dr Paul Aveyard, in the BBC Horizon programme E-Cigarettes – Miracle or Menace said ‘Vaping is like nicotine replacement therapy, but in posh clothes. Clothes that people want to wear.’ By joining up the people who need to stop smoking with an introduction to the product that could help them do that, aren’t we just giving a nudge in the right direction?