Cooley Mary E, Lundin Rebecca, Murray Lyndsay
The Phyllis F. Cantor Center, Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute and College of Nursing and Health Sciences, University of Massachusetts, Boston, USA.
Annu Rev Nurs Res. 2009;27:243-72. doi: 10.1891/0739-6686.27.243.
Smoking cessation is essential after the diagnosis of cancer to improve clinical outcomes. The purpose of this chapter is to provide a systematic review of research on smoking cessation in the context of cancer care with an emphasis on nursing contributions to the field. Data sources included research reports of smoking cessation interventions conducted in people with cancer. Nineteen primary studies were reviewed. High intensity interventions, targeting multiple behaviors, and/or using a multicomponent intervention that included pharmacotherapy, behavioral counseling, and social support were characteristics of the most successful treatments for tobacco dependence. The majority of interventions were conducted in adults with smoking-related malignancies during acute phases of illness. The most striking finding was that more than one half of the studies tested the efficacy of nurse-delivered interventions. Conceptual and methodological issues that can be improved in future studies include: using theoretical frameworks to specify how the intervention will affect outcomes, ensuring adequate sample sizes, using biochemical verification to monitor smoking outcomes, and using standardized outcome measures of abstinence. Although effective interventions are available for healthy populations, further research is needed to determine if tailored cessation interventions are needed for patients with cancer. To provide optimal quality care it is imperative that delivery of evidence-based smoking cessation interventions be integrated into the cancer treatment trajectory. Multiple barriers, including patient and nurse attitudes toward smoking and lack of knowledge related to tobacco treatment, prevent translating evidence-based tobacco dependence treatment into clinical practice. Further nursing research is needed to address these barriers.
癌症诊断后戒烟对于改善临床结果至关重要。本章的目的是对癌症护理背景下的戒烟研究进行系统综述，重点关注护理领域的贡献。数据来源包括针对癌症患者进行的戒烟干预研究报告。共审查了19项主要研究。高强度干预、针对多种行为和/或采用包括药物治疗、行为咨询和社会支持在内的多成分干预是最成功的烟草依赖治疗方法的特点。大多数干预是在患有与吸烟相关恶性肿瘤的成年人疾病急性期进行的。最显著的发现是，超过一半的研究测试了护士提供的干预措施的效果。未来研究中可以改进的概念和方法问题包括：使用理论框架来明确干预将如何影响结果、确保足够的样本量、使用生化验证来监测吸烟结果以及使用标准化的戒烟结果测量方法。虽然有效的干预措施适用于健康人群，但需要进一步研究以确定癌症患者是否需要量身定制的戒烟干预措施。为了提供最佳质量的护理，将基于证据的戒烟干预措施纳入癌症治疗轨迹势在必行。包括患者和护士对吸烟的态度以及与烟草治疗相关的知识缺乏在内的多种障碍，阻碍了将基于证据的烟草依赖治疗转化为临床实践。需要进一步的护理研究来解决这些障碍。
