Notley Caitlin, Belderson Pippa, Ward Emma, Clark Lucy V, Clark Allan, Stirling Susan, Parrott Steve, Li Jinshuo, Coats Timothy J, Bauld Linda, Holland Richard, Gentry Sarah, Agrawal Sanjay, Bloom Benjamin M, Boyle Adrian, Gray Alasdair, Morris M Geraint, Pope Ian
Norwich Medical School, University of East Anglia, Norwich, UK.
Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK.
Nicotine Tob Res. 2025 Apr 22;27(5):909-916. doi: 10.1093/ntr/ntae223.
Hospital emergency departments (ED) offer an opportunity to engage with large numbers of people who smoke to prompt cessation, although the acceptability of opportunistic intervention in this context has been questioned. This process evaluation study was embedded into the Cessation of Smoking Trial in the Emergency Department (COSTED) randomized controlled trial and sought to explore the context of intervention delivery within the ED.
Qualitative interviews were conducted with participants and staff across six EDs participating in the COSTED randomized controlled trial. Interview data were thematically analyzed specifically exploring contextual influences. Data were triangulated with ethnographic observations.
In participant interviews (N = 34), it was acceptable overall to receive a brief opportunistic smoking cessation intervention in the ED. Contextual factors are impacted at a range of levels. At the micro level participant views and experiences combined with staff tailoring were important. Being given an e-cigarette starter kit by a "credible source" helped to legitimize vaping for smoking cessation and gave confidence in personal ability to switch away from tobacco. At the meso level, adaptations to intervention delivery were made in response to the context of the ED. Stop smoking advisors (N = 11) had to adapt and deliver the intervention flexibly depending on space and clinical need. At the macro level, hospital policies supportive of vaping legitimized the approach.
Smoking cessation outcomes reported in the main trial across sites were very similar because of the high credibility, acceptability, and flexible approach to delivering the COSTED intervention in the ED.
Attending a hospital ED is the right time and place to receive smoking cessation intervention, even for those not motivated to quit. People are willing to receive intervention, and clinical staff are willing to support intervention delivery. Despite challenges, overall the context is helpful in supporting people to switch away from tobacco. The intervention, with flexible and tailored implementation, is adaptable to different ED contexts. This suggests that wider implementation across NHS Trusts of the effective COSTED intervention is feasible and will ultimately support smoking cessation for people attending EDs, who may not otherwise have sought support.
医院急诊科为接触大量吸烟人群以促使其戒烟提供了契机，尽管在此背景下机会性干预的可接受性受到了质疑。这项过程评估研究嵌入了急诊科戒烟试验（COSTED）随机对照试验中，旨在探索急诊科内干预实施的背景情况。
对参与COSTED随机对照试验的六个急诊科的参与者和工作人员进行了定性访谈。对访谈数据进行了主题分析，特别探讨了背景影响因素。数据与民族志观察结果进行了三角互证。
在参与者访谈（N = 34）中，总体而言，在急诊科接受简短的机会性戒烟干预是可以接受的。背景因素在多个层面受到影响。在微观层面，参与者的观点和经历与工作人员的个性化调整相结合很重要。由“可靠来源”提供电子烟启动套件有助于使电子烟用于戒烟合法化，并增强个人从烟草转向电子烟的信心。在中观层面，根据急诊科的情况对干预实施进行了调整。戒烟顾问（N = 11）必须根据空间和临床需求灵活调整并实施干预。在宏观层面，支持电子烟的医院政策使该方法合法化。
由于在急诊科实施COSTED干预具有高度可信度、可接受性且方法灵活，各地点主要试验中报告的戒烟结果非常相似。
即使对于那些没有戒烟意愿的人来说，去医院急诊科就诊也是接受戒烟干预的合适时间和地点。人们愿意接受干预，临床工作人员也愿意支持干预的实施。尽管存在挑战，但总体而言，这种背景有助于支持人们从烟草转向其他方式。该干预措施灵活且个性化实施，适用于不同的急诊科情况。这表明在国民保健服务信托机构中更广泛地实施有效的COSTED干预是可行的，最终将支持急诊科就诊者戒烟，否则他们可能不会寻求支持。
