Smoking cessation in the emergency department: a qualitative exploration of staff attitudes
Emergency departments see uniquely large numbers of patients across all demographic groups who are more likely to smoke and who attend with acute health concerns that can provide an impetus for behaviour change. Despite this potential opportunity, no smoking cessation programme in any UK emergency department yet exists. This study sought to identify perceived barriers and facilitators for emergency department smoking cessation activity, as well as potential modes of intervention, by exploring staff attitudes. Methods 16 members of staff from the Emergency Department, Derby NHS Teaching Hospital were purposively sampled to include a spectrum of clinical and non-clinical roles, grades, and employment duration. Semi-structured interviews were conducted within the department, and thematically analysed with dual-coding for validity under an interpretivist paradigm. Findings Three themes were identified: roles of emergency departments, effects of smoking, and scope for intervention. Effects were described in individual-health and department-management contexts, with belief that reducing patient smoking would benefit both. Health promotion was seen as theoretically part of, and practically achievable within, the emergency department role. Lack of organisational support was a key barrier. Staff practice included occasional ad-hoc smoking cessation activity, but nothing routine. Those who did not incorporate smoking cessation into their practice felt that lack of training and support, rather than time, stopped them from doing so. Interpretation Support for emergency department smoking cessation was found in the face of major barriers. Options to address these barriers were suggested, highlighting a willingness to engage. Complex interventions appeared impractical, and no single approach seemed universally applicable to emergency department environments. This study addresses the paucity of evidence around emergency department attitudes towards smoking cessation by providing a unique and in-depth picture of staff in the study department. It also balances clinical and population health viewpoints and has potential to inform promising prevention strategies in the emerging population-focused health-care structures. However, the study might not be generalisable to other emergency departments. Further research exploring patient attitudes would be a valuable next step.