What counseling points should be discussed with patients initiating a nicotine patch for smoking cessation?

From the Guidelines

When counseling patients initiating nicotine patches for smoking cessation, it is essential to discuss key points such as applying one patch daily to clean, dry, hairless skin, rotating sites to prevent skin irritation, and the potential for skin irritation, sleep disturbances, and other side effects, as well as the importance of combining the patch with behavioral counseling and support for optimal success rates, as supported by the most recent and highest quality study 1.

Key Counseling Points

• Patients should apply one patch daily to clean, dry, hairless skin, rotating sites to prevent skin irritation.
• The patch can be worn for up to 24 hours a day, but may cause sleep disturbances, and if that occurs, removing the patch before bedtime is recommended.
• Common side effects include skin irritation, vivid dreams, and insomnia.
• Patches should be stored safely away from children and pets, and used patches folded with adhesive sides together before disposal.
• Patients should be informed that combining the patch with short-acting nicotine replacement therapy (like gum or lozenges) for breakthrough cravings can improve success rates.

Importance of Behavioral Counseling and Support

• Combining pharmacologic therapy and behavior therapy is the most effective approach and leads to the best results for smoking cessation, as stated in the NCCN clinical practice guidelines 1.
• High-intensity behavior therapy with multiple counseling sessions is most effective, but at least a minimum of brief counseling is highly recommended.
• Smoking status should be documented in the patient health record, and patient health records should be updated at regular intervals to indicate changes in smoking status, quit attempts made, and interventions utilized.

Additional Considerations

• Smoking relapse and brief slips are common, and providers should discuss this and provide guidance and support to encourage continued smoking cessation attempts.
• Smoking cessation should be offered as part of oncology treatment and continued throughout the entire oncology care continuum, including during end-of-life care, with an emphasis on patient preferences and values when considering the best approach to fostering smoking cessation during end-of-life care, as recommended by the NCCN clinical practice guidelines 1.

From the FDA Drug Label

If you have vivid dreams, you may remove the patch at bedtime and apply a new one in the morning Do not wear more than one patch at a time Do not cut patch in half or into smaller pieces Do not leave patch on for more than 24 hours because it may irritate your skin and loses strength after 24 hours Apply one new patch every 24 hours on skin that is dry, clean and hairless The used patch should be removed and a new one applied to a different skin site at the same time each day

The correct counseling points for patients initiating a nicotine patch for smoking cessation are:

• The patch can be worn for up to 24 hours a day
• The patch can cause sleep disturbances, and if that occurs, remove the patch before bedtime and apply a new one in the morning
• Place the patch on hairless skin
• Rotate the patch site to avoid skin irritation
• Dispose of the used patch properly by folding the sticky ends together and putting it in the pouch 2

From the Research

Counseling Points for Nicotine Patch Initiation

When initiating a nicotine patch for smoking cessation, several counseling points should be discussed with patients. These include:

• Skin irritation can occur, therefore it is recommended to rotate the patch site and place it on a hairless location 3, 4
• The patch can be worn for up to 24 hours a day, but sleep disturbances may occur, in which case the patch should be removed before bedtime 4, 5
• Patients should be advised to follow the recommended usage and dosage instructions to minimize side effects and ensure effectiveness 6, 7

Key Considerations

Some key considerations when counseling patients on nicotine patch use include:

• Rotating the patch site to minimize skin irritation 3, 4
• Being aware of potential sleep disturbances and removing the patch if necessary 4
• Following the recommended usage and dosage instructions to ensure effectiveness and minimize side effects 6, 7
• Monitoring for adverse reactions, such as application site reactions, and adjusting usage as needed 4

Patient Education

Patient education is crucial when initiating nicotine patch therapy. Patients should be informed about:

• The potential benefits and risks of nicotine patch therapy 3, 5, 6
• How to properly use and apply the patch 6, 7
• What to expect during the treatment period, including potential side effects and withdrawal symptoms 4, 6
• The importance of follow-up and support to ensure successful smoking cessation 6, 7