Background: There is still limited evidence on the effectiveness and implementation of smoking cessation interventions for people with severe mental illness (SMI) in Dutch outpatient psychiatric settings. The present study aimed to establish expert consensus on the core components and strategies to optimise practical implementation of a smoking cessation intervention for people treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Design: A modified Delphi method was applied to reach consensus on three core components (behavioural counselling, pharmacological treatment and peer support) of the intervention. The Delphi panel comprised five experts with different professional backgrounds. We proposed a first intervention concept. The panel critically examined the evolving concept in three iterative rounds of 90 min each. Responses were recorded, transcribed verbatim and thematically analysed. Results: Overall, results yielded that behavioural counselling should focus on preparation for smoking cessation, guidance, relapse prevention and normalisation. Pharmacological treatment consisting of nicotine replacement therapy (NRT), Varenicline or Bupropion, under supervision of a psychiatrist, was recommended. The panel agreed on integrating peer support as a regular part of the intervention, thus fostering emotional and practical support among patients. Treatment of a co-morbid cannabis use disorder needs to be integrated into the intervention if indicated. Regarding implementation, staff’s motivation to support smoking cessation was considered essential. For each ambulatory team, two mental health care professionals will have a central role in delivering the intervention. Conclusions: This study provides insight into expert consensus on the core components of a smoking cessation intervention for people with SMI. The results of this study were used for the development of a comprehensive smoking cessation program.
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BACKGROUND In contrast to several other countries, smoking is not an integral part of treatment during admission to a psychiatric hospital in The Netherlands. AIM Implementation of a smoking cessation program for patients and employees of a psychiatric ward of an academic medical center in The Netherlands. METHOD Prospective, mixed-method study of implementation of a smoking cessation program for patients and employees of a psychiatric academic hospital in Amsterdam. The program consisted of 7 weekly group meetings by certified smoking cessation coaches. Nicotine replacement therapy was provided for free, if necessary. RESULTS During 14 months, 65 individuals were seeking help to stop smoking: 39 patients and 26 employees. Of these, 29 patients and 16 employees participated in group meetings with an average of 2.6 times per person. There were 20 individuals who visited the group meetings or received individual coaching at least 3 times (6 patients and 14 employees). Fifty-five percent of these individuals reported to be smoke-free at 3 months after joining the first meeting. Employees were much more likely to quit than patients. From interviews with 20 participants, it was noticed that combining patients and employees in one group was perceived as a barrier due to a gap in processing speed. CONCLUSION On the psychiatric ward of an academic hospital in The Netherlands, there was a positive experience with providing smoking cessation treatment. A small number of employees and patients participated in a smoking cessation program and quitting smoking was reached by only a few patients. Supporting smoking cessation in a psychiatric hospital asks for intensive screening, diagnosing, treatment and smoke-free policies.
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Abstract Background Smoking among people with severe mental illness (SMI) is highly prevalent and strongly associated with poor physical health. Currently, evidence-based smoking cessation interventions are scarce and need to be integrated into current mental health care treatment guidelines and clinical practice. Therefore, the present study aims to evaluate the implementation and efectiveness of a smoking cessation intervention in comparison with usual care in people with SMI treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Methods A pragmatic, cluster-randomised controlled trial with embedded process evaluation will be conducted. Randomisation will be performed at the level of FACT teams, which will be assigned to the KISMET intervention or a control group (care as usual). The intervention will include pharmacological treatment combined with behavioural counselling and peer support provided by trained mental health care professionals. The intervention was developed using a Delphi study, through which a consensus was reached on the core elements of the intervention. We aim to include a total of 318 people with SMI (aged 18–65 years) who smoke and desire to quit smoking. The primary outcome is smoking status, as verifed by carbon monoxide measurements and self-report. The secondary outcomes are depression and anxiety, psychotic symptoms, physical ftness, cardiovascular risks, substance use, quality of life, and health-related self-efcacy at 12months. Alongside the trial, a qualitative process evaluation will be conducted to evaluate the barriers to and facilitators of its implementation as well as the satisfaction and experiences of both patients and mental health care professionals. Discussion The results of the KISMET trial will contribute to the evidence gap of efective smoking cessation interventions for people treated by FACT teams. Moreover, insights will be obtained regarding the implementation process of the intervention in current mental health care. The outcomes should advance the understanding of the interdependence of physical and mental health and the gradual integration of both within the mental health care system. Trial registration Netherlands Trial Register, NTR9783. Registered on 18 October 2021.
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In het forensisch werkveld staan drie vragen centraal. Het gaat dan om “wie is het”, “wat is er gebeurd” en “wanneer is het gebeurd”. Alle informatie die bijdraagt aan het beantwoorden van deze vragen is waardevol in zaakonderzoeken. Vaak wordt er wel een biologisch spoor gevonden, maar is er geen “match” met de databank. In dit geval kan profileringsinformatie helpen bij het zoeken naar de juiste persoon. Met profilering wordt hier bedoeld een serie stoffen, ook markers genoemd, die informatie geven over de levensstijl van mensen. De levensstijl kan bestaan uit kenmerken, voeding, gewoonten en activiteiten. Een recent voorbeeld van een profileringsmethode is het analyseren van de buitenzijde van mobiele telefoons. Door het hanteren van de telefoon laten mensen zweet en stoffen achter die gekarakteriseerd kunnen worden. Het profiel van deze stoffen geeft een beschrijving van de levensstijl van de eigenaar. In veel zaken zijn er echter geen mobiele telefoon aanwezig, maar wel andere sporen zoals haar. Daarom is er behoefte aan een methode om haar te gebruiken voor profilering. Bovendien geeft haar een indicatie van tijd en gebeurtenissen uit het verleden omdat het langzaam groeit. In principe kan er dan informatie over de drie vragen (wie, wat, wanneer) verzameld worden. Haren worden op dit moment vooral gebruikt voor het meten van drugs, alcohol gebruik, cortisol en nicotine. Er is echter behoefte aan een breder palet van stoffen dat in één keer in haar kan worden gemeten. Het doel van dit onderzoek is daarom het ontwikkelen van een methode waarmee in één analysegang een profiel van circa 15 uiteenlopende markers kan worden gemeten.
