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

Abstract

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.

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

“…20,21 Third, surgeons often doubt the efficacy of their own counseling—noting that long-term smokers are unlikely to be motivated to quit. 12,22 We found these concerns to be widely present in our preliminary work 7 despite a large body of evidence showing that perioperative smoking cessation counseling efforts by surgeons can be successful. 23 …”

Implementing Facilitated Access to a Text Messaging, Smoking Cessation Intervention Among Swedish Patients Having Elective Surgery: Qualitative Study of Patients’ and Health Care Professionals’ Perspectives

“…Practitioners suggested that identifying and recruiting patients would be more efficient in primary care rather than waiting for the surgery department to refer patients. Previous research has highlighted that preoperative interventions are indeed difficult to implement and that primary care is an ideal setting for implementing smoking cessation [ 39 ]. This has implications for future implementation efforts of similar interventions in terms of when to introduce similar interventions for smoking cessation support in health care organizations.…”

Anesthesiologists and the Other Pandemic: Tobacco Use

“…Other surveys of anesthesiologists and surgeons have found similar results. [132][133][134][135][136][137][138]…”