Antenatal Clinic and Stop Smoking Services Staff Views on "Opt-Out" Referrals for Smoking Cessation in Pregnancy: A Framework Analysis.

Katarzyna Anna Campbell,Sue Cooper,Felix Naughton,Katharine Anna Bowker,Tim Coleman,Melanie Sloan

doi:10.3390/ijerph13101004

Abstract

Introduction: UK guidance recommends routine exhaled carbon monoxide (CO) screening for pregnant women and “opt-out” referrals to stop smoking services (SSS) of those with CO ≥ 4 ppm. We explored staff views on this referral pathway when implemented in one UK hospital Trust. Methods: Seventeen semi-structured interviews with staff involved in the implementation of the new referral pathway: six antenatal clinic staff (before and after implementation); five SSS staff (after). Data were analyzed using framework analysis. Results: Two themes were identified: (1) views on implementation of the pathway and (2) impact of the pathway on the women. Generally, staff felt that following training, referrals were less arduous to implement and better received than expected. The majority believed this pathway helped engage women motivated to quit and offered a unique chance to impart smoking cessation knowledge to hard-to-reach women, who might not otherwise contact SSS. An unexpected issue arose during implementation—dealing with non-smokers with high CO readings. Conclusions: According to staff, the “opt-out” referral pathway is an acceptable addition to routine antenatal care. It can help engage hard-to-reach women and educate them about the dangers of smoking in pregnancy. Incorporating advice on dealing with non-smokers with high CO into routine staff training could help future implementations.

Highlights

UK guidance recommends routine exhaled carbon monoxide (CO) screening for pregnant women and “opt-out” referrals to stop smoking services (SSS) of those with CO ≥ 4 ppm.We explored staff views on this referral pathway when implemented in one UK hospital Trust
The responses of the participants were categorized into two broad themes: (1) views on implementation of the pathway, including the impact it had on their professional roles, their reflections on their own confidence to administer the pathway, and their ability to engage the pregnant women; (2) impact of the pathway on the women, both smokers and self-reported non-smokers
They were concerned that the time necessary to engage in the “opt-out”

Summary

Introduction

UK guidance recommends routine exhaled carbon monoxide (CO) screening for pregnant women and “opt-out” referrals to stop smoking services (SSS) of those with CO ≥ 4 ppm.We explored staff views on this referral pathway when implemented in one UK hospital Trust. UK guidance recommends routine exhaled carbon monoxide (CO) screening for pregnant women and “opt-out” referrals to stop smoking services (SSS) of those with CO ≥ 4 ppm. Evidence has shown that many pregnant smokers do not disclose their smoking status to healthcare professionals [2,3], but engaging them with healthcare services is necessary to provide cessation support, and improves chances of quitting during pregnancy [4]. In the UK, the National Institute for Health and Care Excellence (NICE) guidelines for smoking cessation in pregnancy recommend an integrated “opt-out” referral pathway from antenatal care to the SSS [7].

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