A Systematic Literature Review of Self-Reported Smoking Cessation Counseling by Primary Care Physicians

Abstract

Tobacco consumption is a risk factor for chronic diseases and worldwide around six million people die from long-term exposure to first- or second-hand smoke annually. One effective approach to tobacco control is smoking cessation counseling by primary care physicians. However, research suggests that smoking cessation counseling is not sufficiently implemented in primary care. In order to understand and address the discrepancy between evidence and practice, an overview of counseling practices is needed. Therefore, the aim of this systematic literature review is to assess the frequency of smoking cessation counseling in primary care. Self-reported counseling behavior by physicians is categorized according to the 5A’s strategy (ask, advise, assess, assist, arrange). An electronic database search was performed in Embase, Medline, PsycINFO, CINAHL and the Cochrane Library and overall, 3491 records were identified. After duplicates were removed, the title and abstracts of 2468 articles were screened for eligibility according to inclusion/exclusion criteria. The remaining 97 full-text articles reporting smoking cessation counseling by primary care physicians were assessed for eligibility. Eligible studies were those that measured physicians’ self-reported smoking cessation counseling activities via questionnaire. Thirty-five articles were included in the final review (1 intervention and 34 cross-sectional studies). On average, behavior corresponding to the 5A’s was reported by 65% of physicians for “Ask”, 63% for “Advise”, 36% for “Assess”, 44% for “Assist”, and 22% of physicians for “Arrange”, although the measurement and reporting of each of these counseling practices varied across studies. Overall, the results indicate that the first strategies (ask, advise) were more frequently reported than the subsequent strategies (assess, assist, arrange). Moreover, there was considerable variation in the items used to assess counseling behaviour and developing a standardized instrument to assess the counseling strategies implemented in primary care would help to identify and address current gaps in practice.

Good practice regarding smoking cessation management in Spain: Challenges and opportunities for primary care physicians and nurses

“…In contrast to our findings, a review in 2016 19 described considerable discrepancies among the different elements that make up GP with regard to PC physicians. From the 35 articles that were included, the following was observed: 65% Ask, 63% Advise, 36% Assess, 44% Asist, and only 22% Arrange (follow-up).…”

Twelve Million Smokers Look Online for Smoking Cessation Help Annually: Health Information National Trends Survey Data, 2005–2017

“…Estimates of the potential impact for other cessation modalities delivered “in the wild” may also represent an upper bound. For example, health care providers may not deliver brief advice at all or as effectively as in clinical trials, 17–19 and smokers may not adhere to recommended dosing or usage guidelines for NRT. Our analyses illustrate the potential impact of each modality based on best available estimates of reach and effectiveness.…”

Low Burden Strategies Are Needed to Reduce Smoking in Rural Healthcare Settings: A Lesson from Cancer Clinics

“…Although prior research has reported that brief advice may be delivered in more than half of clinical encounters in oncology and primary care settings [33][34][35], the documentation of brief advice in the EHR within a large healthcare system is not well-known and likely to be highly variable across clinics and providers. We found that treatment engagement in both urban and rural clinics was considerably lower than these previous estimates, and we have strengthened this brief advice component by providing a standardized script for providers and integrating brief advice and other intervention components into the regular workflow.…”