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Tobacco treatment program expands scope of care

IU Health North Hospital

Tobacco treatment program expands scope of care

It started with patients of IU Health Simon Cancer Center and now the Tobacco Treatment Program is expanding to all patients.

By IU Health Senior Journalist, T.J. Banes,

She’s been a smoker since she was about 18 and Linda Purvis has tried more than once to kick the habit. At one point she quit for about six months.

“I don’t really know why I smoke. I guess it relaxes me,” said Purvis, a resident of Fairland. She comes to IU Health Simon Cancer Center for infusion treatments for Crohn’s disease. On a recent visit, she met with social worker and Tobacco Cessation Counselor Danielle Barwise for a tobacco treatment consultation.

For the past 15 months, IU Health has offered tobacco treatment consultations to oncology patients and recently expanded to all patients. Physicians, nurses and medical assistants generally refer patients to Barwise. She also takes referrals from IU Health North’s Schwarz Cancer Center. She averages five patients a day, about 140 active patients at any given time.

On Barwise’s initial visit with Purvis, she asked questions ranging from frequency of tobacco use to reasons for using. She then tried to gage her patient’s motivation for quitting.

“Helping patients quit tobacco use improves health outcomes significantly,” said Barwise. “Some tobacco users may think it’s too late, that the damage is already done or they may be feeling overwhelmed with their diagnosis and treatment, so they aren’t really thinking about quitting tobacco. But what many people don’t know is that continued tobacco use after a diagnosis can interfere with treatment and make prognosis worse. Quitting tobacco can improve symptoms, improve their recovery and improve long-term outcomes.”

Purvis, who has been married for 30 years, is the mother to two boys ages 26 and 28. She says she begins craving a Pall Mall Light about 15 minutes after she wakes up and on average smokes a pack a day. She says her sons are her biggest motivation for quitting.

After several questions, Barwise conducts a carbon monoxide test – having Purvis blow into a handheld monitor. She explains that different factors may impact the test number - how recent Purvis smoked, if she smokes inside her home or car, how deeply she inhales, and if she relights cigarettes. It provides Purvis with a baseline of the carbon monoxide in her body, caused from tobacco use. A pack-a-day smoker can have a 3-6 percent carbon monoxide level in their blood. The levels can increase based on the number of cigarettes.

Barwise then asks patients to give a number on a scale of 0-10 demonstrating their willingness to quit smoking. She follows up with patients, re-administering the carbon monoxide test, and provides them with resources and techniques to help motivate them to stop smoking. Barwise will revisit Parvis on her next appointment in April.

She typically follows up with patients every two-three weeks. Some patients require additional follow up if they are starting a medication to help them stop smoking. During each session Barwise reviews topics discussed in previous sessions. Patients are also given a handbook to help guide them through the process.

As part of the counseling Barwise focuses on encouraging patients to make choices that help them regain control over their health. Patients learn that smoking is a behavior and an addiction to nicotine. They are urged to set goals – find reasons to quit, strategize for change, and keep a log of their tobacco use. Patients also receive support in dealing with stress and identifying and coping with triggers for smoking.

“Helping patients quit tobacco is the most rewarding feeling,” said Barwise. “Patients appreciate having someone who encourages them and someone who makes themselves available to listen. I have met with several patients after they quit tobacco that report their tumors have shrunk, their wounds are healing faster and they just have more of an overall healthy attitude. And several patients who quit are then motivated to help others quit.”

Smoking-related illnesses claim more than 11,000 Indiana residents each year and tobacco use results in well over $7 billion in health costs annually. As the state’s largest healthcare system, IU Health is committed to reducing the number of people who smoke and dissuading others from starting.

So IU Health joins a statewide campaign against tobacco use. The campaign promotes reduced incidents of cancer, pulmonary disease, infant mortality, and other health-related issues.

Since the program started, nearly 100 patients have quit smoking.