Impact and Duration of Brief Surgeon-Delivered Smoking Cessation Advice on Attitudes Regarding Nicotine Dependence and Tobacco Harms for Patients with Peripheral Arterial Disease

Abstract

Background Despite the recognized benefits of smoking cessation, many clinicians question if a brief smoking cessation intervention can help dedicated smokers with peripheral arterial disease understand nicotine dependence and harms related to smoking. We investigated the impact and durability of a multi-modal smoking cessation intervention on patient attitudes regarding nicotine dependence and the health effects of smoking. Methods We conducted a pilot cluster randomized trial of a brief smoking cessation intervention at eight vascular surgery practices between September 1, 2014 and August 31, 2015. Compared with control sites, patients at intervention sites received protocolized brief cessation counseling, medications and referrals to a quitline. After their clinic visit and again at 3 months, participants completed a brief survey about patient attitudes regarding nicotine dependence and the health effects of smoking. Responses to questions were analyzed using Chi2 and student’s t-tests. Results All trial participants (n=156) complete the initial survey, and 75 (45%) participants completed the follow-up survey. Intervention and control patients both reported a greater than 30-pack-year history (80% vs 90%, p=0.07) and previous failed quit attempts (77% vs 78%, p=0.8). Compared to usual care, patients in the intervention group were more likely to describe hearing advice to quit from their surgeon (98% vs. 77%, p<0.001), and expressed “a lot” or “some” interest in quitting (95.4% vs 85.7%, p=0.05). Patients in the intervention group were also more likely to acknowledge their addictive behaviors, consistently scoring higher on question bank items regarding nicotine addiction (52.9 vs 48.0, p=0.006) and the negative health effects of smoking (scaled score 56.6 vs 50.6, p=0.001). When re-surveyed three months after intervention, patients in the intervention group had larger declines in nicotine dependence and health effects domains, suggesting durable impact of the intervention on patient attitudes regarding nicotine addiction and smoking harms. Conclusions Brief smoking cessation counseling by a vascular surgeon increases patient interest in smoking cessation and awareness of smoking harms, and this effect was durable three months after intervention. This evidence suggests that even brief counseling within a surgical clinic has the potential to impact patient desire to quit.

Predictors of returns to the emergency department after head and neck surgery

“…The importance of patient education and counseling regarding smoking cessation in the perioperative period cannot be overstated. Perioperative tobacco cessation counseling has been associated with reduced postoperative complications . Cases of COPD were also found to be predictors of 30dEDRs on univariate analysis ( P = .01).…”

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Role of procedural intervention and acute illness in veterans affairs smoking cessation program referrals: A retrospective study

“…Our findings build on prior work by Tang et al 21 who promote a surgeon-led script promoting referral to stop smoking resources for patients with newly diagnosed head and neck cancer. Similarly, a cluster-randomized trial by Newhall et al 22 demonstrated effectiveness of surgeon-delivered smoking cessation advice in increasing interest and awareness in smoking cessation for patients with vascular surgical problems.…”

<p>Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence</p>

“…A brief smoking cessation (3 months) with the help of vascular surgeon can increase patients’ desire to quit. It is also important to make patients aware of the possible long-term consequences of nicotine dependence 89. The VAPOR trial (Vascular Physician Offer and Report) designed a three-step smoking cessation intervention (advising to quit, replacing nicotine, telephone-followed quitline) and compared it to routine care.…”