A Population-Based Survey of Physician Smoking Cessation Counseling Practices

Goldstein, Michael G.; DePue, Judith D.; Monroe, Alicia D.; Willey, Cynthia; Rakowski, William; Prokhorov, Alexandre V; Niaura, Raymond; Dubé, Catherine

doi:10.1006/pmed.1998.0350

Cited by 141 publications

(115 citation statements)

References 34 publications

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“…While smoking cessation prior to surgery reduces surgical complications, the benefits of preoperative cessation have more far reaching effects, including improved lung function [20] and increased life expectancy [21]. While our findings that most practitioners ask and advise patients about smoking are in line with other studies, including national surveys of health professionals smoking cessation beliefs and practices [22][23][24], there is variation in the literature regarding whether physicians believe that smoking cessation counseling is effective, with estimates ranging from less than 33% to 62% [24,25]. This variation in beliefs regarding the effectiveness of smoking cessation counseling may be related to why not all physicians in our study feel that surgery should be delayed.…”

Section: Original Researchsupporting

confidence: 81%

Translating preoperative smoking cessation interventions into routine clinical care of veterans: provider beliefs

Vick

Graham

Henderson³

et al. 2011

Behav. Med. Pract. Policy Res.

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Smoking among veterans undergoing surgery is estimated to be 36%. Smoking has been linked to postoperative surgical complications including ischemia and cardiac arrhythmias, pneumonia, deep venous thrombosis, pulmonary embolism, and surgical site infection. Preoperative smoking cessation interventions, in which smokers quit at least 6weeks prior to surgery, have been shown to be effective both in smoking cessation and reduction of postoperative complications; however, little is known about physician beliefs regarding the optimal location and the responsible provider for intervention, or whether surgery should be postponed or delayed based on smoking status. Within the routine coordination from medical to surgical care, how should cessation interventions best be implemented? To better inform the translation of preoperative best practices for smoking cessation into clinical care in VA, a survey regarding preoperative smoking cessation beliefs and practices was administered to primary care physicians, surgeons, and anesthesia providers. Chi-square tests were used to examine differences in proportions by provider type. Most providers agreed that the primary care clinic is the best location for intervention, with preoperative and surgical clinics ranked by few as the optimal location (13% and 11%, respectively); most respondents (82%) reported that they would refuse or delay surgery in some cases based on smoking status. There were no differences in either beliefs on location or delay based on provider type. Primary care providers were most likely to advise (86.7%) and assess (80.0%) while anesthesia providers were least likely (59.1% and 22.7%, respectively). Taking time to counsel and the belief that dedicated resources would improve quit rates were associated with advising patients to quit smoking, while being uncomfortable with counseling, the belief that acute health takes precedence and the belief that there is not always time to counsel were identified as barriers to assessing patients for smoking cessation intervention. Primary care providers were more optimistic (100%) that patients would quit if counseled, more often (73.3%) reported having time to counsel, and were less likely to report that acute health takes precedence. Most providers believe that smoking cessation would reduce postoperative complications, with the ideal location for the intervention being the primary care clinic, and that some surgical cases should be delayed for this intervention.

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Section: Original Researchsupporting

confidence: 81%

Translating preoperative smoking cessation interventions into routine clinical care of veterans: provider beliefs

Vick

Graham

Henderson³

et al. 2011

Behav. Med. Pract. Policy Res.

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“…These reported methods of smoking cessation are shown in Figure 1. We also found that 289 (66.3%) of the physicians reported that poor knowledge of smoking cessation interventions was an obstacle 14 smoking patients. It has been demonstrated that follow-up visits during the abstinence period often provide the physician with an opportunity to review the progress of smoking cessation, congratulate the patient, stress abstinence, identify problems (current and potential) and initiate a new intervention or modify the current one if necessary.…”

Section: Discussionmentioning

confidence: 67%

“…(13) A study involving doctors in the United States reported that 67% asked about smoking and 74% advised their patients to quit, but only 35% provided assistance in quitting and only 8% scheduled follow-up visits. (14) A 2004 survey of 4,000 doctors in China revealed that less than half (48%) asked patients about their smoking status, 64% advised known smokers to quit, 6.1% set quit dates, and 6.6% prescribed pharmacotherapy to help smokers quit. (15) The success of smoking abstinence is often determined by the knowledge and practices of the physician regarding smoking cessation.…”

Section: Introductionmentioning

confidence: 99%

Knowledge of and practices related to smoking cessation among physicians in Nigeria

et al. 2009

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Objective: To evaluate the knowledge and practices of smoking cessation among physicians in Nigeria. Methods: We conducted a cross-sectional survey in Lagos and three geopolitical zones of Nigeria. A self-administered structured questionnaire was used to obtain information on tobacco use and its health effects, as well as on the knowledge and practices of smoking cessation, from 436 physicians. Results: Of the 436 physicians, 292 (67.0%) were aware of smoking cessation, but only 132 (30.3%) showed good knowledge on this topic. The prevalence of smoking among the physicians was 17.7%. In addition, 308 physicians (70.6%) reported that tobacco education in the medical school curriculum was inadequate. Of the 436 physicians, 372 (86.2%) asked their patients whether they smoked, and 172 (39.4%) asked their patients the reasons for using tobacco. As a means of smoking cessation intervention, 268 (61.5%) used brief advice/counseling (2-5 min), 12 (3.7%) prescribed antidepressants, 16 (2.8%) prescribed nicotine replacement therapy (NRT), and 76 (17.4%) arranged follow-up visits. When the physicians were questioned regarding the obstacles to smoking cessation interventions, 289 (66.3%) cited poor knowledge of the issue, 55 (12.6%) cited a lack of time, and 20 (4.6%) cited unavailability of NRT. Conclusions: The results of this study highlight the lack of knowledge among physicians in Nigeria in terms of smoking cessation, as well as their failure to apply appropriate practices. The results of this study can further the evaluation and formulation of guidelines on smoking cessation and smoking education programs for physicians. Our findings also underscore the need to offer smoking cessation programs in all treatment facilities.Keywords: Smoking cessation; Tobacco; Physicians; Nigeria; Health knowledge, attitudes, practice. ResumoObjetivo: Avaliar o conhecimento e as práticas para a cessação do tabagismo entre médicos na Nigéria. Métodos: Um inquérito transversal foi realizado na cidade de Lagos e em três zonas geopolíticas da Nigéria. Um questionário estruturado de autopreenchimento foi respondido por 436 médicos para a obtenção de informações a respeito do uso de tabaco e de seus efeitos na saúde, seu conhecimento e as práticas para cessação do tabagismo. Resultados: Dos 436 médicos, 292 (67,0%) estavam informados a respeito da cessação do tabagismo, mas somente 132 (30,3%) demonstraram bons conhecimentos sobre esse assunto. A prevalência de tabagismo entre os médicos foi de 17,7%. Além disso, 308 médicos (70,6%) relataram que a educação sobre tabagismo nos currículos de medicina era inadequada. Dos 436 médicos, 372 (86,2%) questionavam seus pacientes quanto ao tabagismo, e 172 (39,4%) os questionavam quanto aos motivos para o fumo. Como forma de intervenção para a cessação do tabagismo, 268 (61,5%) utilizavam breve aconselhamento (2-5 min), 12 (3,7%) prescreviam antidepressivos, 16 (2,8%) prescreviam terapia de reposição nicotínica (TRN), e 76 (17,4%) agendavam consultas de acompanhamento. Quando os médicos eram...

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“…The measures were adapted from prior studies (Borrelli et al, 2001;Goldstein et al, 1998). On all measures, higher values indicate more favorable attitudes.…”

Section: Methodsmentioning

confidence: 99%

Is provider training effective? Changes in attitudes towards smoking cessation counseling and counseling behaviors of home health care nurses

Borrelli

Lee

Novak

2008

Preventive Medicine

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Objective-We prospectively examined whether training home health care nurses is associated with changes in attitudes towards smoking cessation counseling and counseling behaviors.Methods-We trained 98 home health care nurses to deliver cessation counseling to their patients. Measures were administered at pre-training, post-training, and six months later. This was part of a larger study conducted in Providence, RI, USA (1998-2002.Results-Compared with pre-training, at post-training, nurses reported significantly higher levels of self-efficacy to counsel, positive outcome expectations, optimism that patients would follow their advice, perceived worth of smoking counseling, perceived importance of quitting smoking, and perceived organizational support. These training effects were maintained six-months later. Between the end of training and the six-month follow-up, nurses reported significant increases in their perceived effectiveness to counsel smokers and confidence to encourage behavior change. Compared with pre-training, at six month follow-up, nurses were significantly more likely to ask about smoking status, assess readiness to quit, advise to quit, assist with quitting, and arrange follow-up. Nurses spent significantly more time counseling smokers at 6 months than at pre-training, and were less likely to selectively counsel.Conclusions-Brief training facilitates both short-and long-term changes in nurse attitudes and behaviors regarding smoking cessation counseling.

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A Population-Based Survey of Physician Smoking Cessation Counseling Practices

Cited by 141 publications

References 34 publications

Translating preoperative smoking cessation interventions into routine clinical care of veterans: provider beliefs

Translating preoperative smoking cessation interventions into routine clinical care of veterans: provider beliefs

Knowledge of and practices related to smoking cessation among physicians in Nigeria

Is provider training effective? Changes in attitudes towards smoking cessation counseling and counseling behaviors of home health care nurses

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