Hospital doctors' attitudes toward giving their patients smoking cessation help

Attitudes and practices of health care providers towards improving adherence to smoking cessation medications in Australia: A descriptive study

ISSUE ADDRESSED

Adherence to smoking cessation medications is low and predicts the success of quit attempts. Health care providers (HCPs) role in delivering smoking cessation support is crucial. HCPs support to improve adherence to smoking cessation medication has not been evaluated in Australia. This study describes the attitudes and practices of HCPs in Australia towards adherence to smoking cessation medications (nicotine replacement therapies, varenicline and bupropion) and intervention options.

METHODS

A descriptive cross-sectional study was conducted using a convenience sample of 70 HCPs in Australia. Participants were recruited through the social media platforms of professional societies in Australia. Data was collected in the periods between November 2020 and September 2021. Descriptive statistics were performed using SPSS statistical software version 27.0 and data was presented using proportions and percentages.

RESULTS

The majority of participants were doctors, nurses and midwives (82.8%). Almost two-thirds of the participants (68.6%) self-reported that they provided adequate adherence support to individuals taking smoking cessation medications. The majority of participants (87.1%) identified adherence support service as part of their professional role. Only 11.1% of the participants who did not believe supporting medication adherence to be their role reported providing adherence support. The main perceived barriers to adherence support are lack of skill, knowledge, time and resources. HCPs believed that providing additional counselling and monitoring of adherence can improve adherence rates.

CONCLUSIONS

In an online survey conducted in Australia, HCPs indicated multiple barriers to providing adherence support and intervention strategies that should be considered for smoking cessation programs. A higher proportion of participants who perceived adherence support as their professional role reported supporting adherence to smoking cessation medications. SO WHAT?: Considerations should be given to improve HCPs attitudes and practices towards smoking cessation medications adherence support. Smoking cessation programs should consider the issue of adherence support. Further studies with a larger sample size across a broader range of HCPs are needed to extensively understand adherence service provision among HCPs in Australia.

Health Workers' Practice Towards Smoking Cessation Intervention Based on 5A's Model and Associated Factors in Public Hospitals, Hadiya Zone, Southern Ethiopia

Background

The tobacco pandemic is one of the world's most serious public health concerns, killing more than 8 million lives per year. The worst burden is in low- and middle-income countries. Unless appropriate action is taken, the burden may worsen. Health workers are among the actors to implement smoke cessation interventions. However, the level of intervention practices towards smoke cessation was not defined.

Objective

To determine health workers' practice towards smoke cessation interventions based on 5A's model and associated factors in public hospitals.

Methods

Facility-based cross-sectional design was used. All public hospitals found in the Hadiya zone were included in the study. From each public hospital, representative number of health workers, who fulfil inclusion criteria, were included in the study. A total of 323 sample size of health workers were used. A self-administered questionnaire was employed to collect data. Both descriptive and advanced analyses were performed using SPSS software version 20.0. In bivariable analysis, variables with p-value < 0.25 were considered for multivariable analysis. Finally, odds ratio with 95% CI and p-value < 0.05 were used to declare factors as significantly associated with the outcome variable.

Results

About 97% of health care workers had poor practice on smoking cessation interventions. About 7.4% (23) health workers reported as they were current smokers. Moreover, only 28% of health workers asked their patients about smoking status. Being females, having <10 years of service, training and having good knowledge was significantly associated with the outcome variable.

Conclusion

Majority of the healthcare workers surveyed did not provide smoking cessation interventions. Identified statistically significant factors with the practice of smoke cessation interventions in this study were sex, knowledge, training and service years. Therefore, strategies should be designed and implemented to improve and equip the health workers towards practising of smoke cessation interventions by instituting smoke cessation programs.

Prevalence and determinants of quitting smoking after cancer diagnosis: a prospective cohort study

OBJECTIVE

To describe smoking behaviours of patients with incident cancer attending an Italian cancer centre and to examine changes in their smoking habits within 12 months from cancer diagnosis, evaluating determinants of smoking cessation.

METHODS

A hospital-based prospective cohort included patients hospitalized in an Italian cancer centre (2016-2018). Patients were mostly female (74%) and included a limited proportion of aerodigestive cancers (7%). Face-to-face interviews were performed during hospital stay to gather information on patient characteristics and smoking history. Changes in smoking habits were assessed through telephone interviews at 3, at 6, and at 12 months after cancer diagnosis.

RESULTS

Among 1011 enrolled patients, 222 (22%) were current smokers at cancer diagnosis. Smoking prevalence was high in male patients (30%), in patients <50 years old (28%), in those with aerodigestive cancers (50%), and in those diagnosed at advanced stages (26%). Among current smokers at cancer diagnosis, 38% quit smoking after 12 months, 26% reduced intensity, and 36% did not modify smoking habits. Smoking cessation was associated with chemotherapy and, although not statistically significant, with female sex, older age, and advanced cancer stage. Patients with gastrointestinal, breast, or genitourinary cancer and those treated with surgery were less likely to quit smoking.

CONCLUSIONS

Our results highlighted that 62% of smoking patients with cancer did not quit the habit. Smoking cessation programs targeted to patients with cancer need intensification, particularly for those who may underestimate smoking effects after diagnosis.

Facilitating smoking cessation in patients who smoke: a large-scale cross-sectional comparison of fourteen groups of healthcare providers

Background

Although healthcare providers are well placed to help smokers quit, implementation of smoking cessation care is still suboptimal. The Ask-Advise-Refer tasks are important aspects of smoking cessation care. We examined to which extent a large and diverse sample of healthcare providers expressed the intention to implement smoking cessation care and which barriers they encountered. We moreover examined to which extent the Ask-Advise-Refer tasks were implemented as intended, and which determinants (in interaction) influenced intentions and the implementation of Ask-Advise-Refer.

Methods

Cross-sectional survey among addiction specialists, anaesthesiologists, cardiologists, general practitioners, internists, neurologists, paediatricians, pulmonologists, ophthalmologists, surgeons, youth specialists, dental hygienists, dentists, and midwives (N = 883). Data were analysed using multivariate linear and logistic regression analyses and regression tree analyses.

Results

The Ask-Advice-Refer tasks were best implemented among general practitioners, pulmonologists, midwives, and addiction specialists. Overall we found a large discrepancy between asking patients about smoking status and advising smokers to quit. Participants mentioned lack of time, lack of training, lack of motivation to quit in patients, and smoking being a sensitive subject as barriers to smoking cessation care. Regression analyses showed that the most important determinants of intentions and implementation of Ask-Advise-Refer were profession, role identity, skills, guideline familiarity and collaboration agreements for smoking cessation care with primary care. Determinants interacted in explaining outcomes.

Conclusions

There is much to be gained in smoking cessation care, given that implementation of Ask-Advise-Refer is still relatively low. In order to improve smoking cessation care, changes are needed at the level of the healthcare provider (i.e., facilitate role identity and skills) and the organization (i.e., facilitate collaboration agreements and guideline familiarity). Change efforts should be directed towards the specific barriers encountered by healthcare providers, the contexts that they work in, and the patients that they work with.

"It's on everyone's plate": a qualitative study into physicians' perceptions of responsibility for smoking cessation

BACKGROUND

Little research has investigated in-depth how physicians perceive their role in smoking cessation care. This qualitative study sought to understand physicians' perceptions of responsibility for smoking cessation.

METHODS

Data were collected through individual semi-structured interviews and focus group interviews between June and November 2017 in The Netherlands. We interviewed 5 addiction specialists, 5 anesthesiologist, 4 cardiologists, 8 GPs, 5 internists, 5 neurologists, 2 pediatricians, 6 pulmonologists, 7 surgeons, and 8 youth healthcare physicians (N = 55). Data analysis followed the framework approach.

RESULTS

The analysis showed that three actors were perceived as responsible for smoking cessation: physicians, patients, and the government. Participants perceived physicians as responsible for facilitating smoking cessation -albeit to different extents-, patients as carrying the ultimate responsibility for quitting smoking, and the government as responsible for creating a society in which smoking uptake is more difficult and quitting smoking easier. Perceptions of smoking itself were found to be important for how participants viewed responsibility for smoking cessation. It remained unclear for many participants which healthcare provider is responsible for smoking cessation care.

CONCLUSIONS

The organization of smoking cessation care within health systems should be a focus of intervention, to better define physician roles and perceptions of responsibility. In addition, it seems important to target perceptions of smoking itself on the level of physicians and -as suggested by comments by several participants- the government.

'Passed and cleared' - Former tobacco smokers' experience in quitting smoking

The literature contains many reports on cigarette smokers and smoking cessation, but there are fewer qualitative studies on smokers' and ex-smokers' experiences with smoking cessation and health care professionals. The aim of the present study was to give voice to ex-smokers' own experiences with smoking cessation through the health care system. The study collected data from focus group interviews with 28 informants divided into four groups. Results from this study do not point to one particular reason for successful smoking cessation, but instead to the combination of pressures from several factors. The informants seem to have reached a point where external pressure made them receptive to: the fear of diseases, legislation, taking advice from health care personnel, views of children and grandchildren and providing a new identity as ex-smoker. Factors that helped to quit were: recent efforts to make it difficult to smoke in Norway, encouragement to seek help to change their tobacco habits, smoking cessation programmes that are integrated into health care practice, health professionals who demonstrate sensitivity and genuine interest during their meetings with smokers. Health professionals in specialized health care must be made aware of their role as the first important step in their patients' road to quitting smoking.

Hospital doctors' smoking behavior and attitude towards smoking cessation interventions for patients: a survey in an Italian Comprehensive Cancer Centre

PURPOSE

Tobacco control guidelines recommend all healthcare professionals to ask patients about their smoking status and to offer them at least minimal cessation advice. However, few data are available about the daily practice of hospital clinicians who work with smoking cancer patients. This study assesses, in a comprehensive cancer center, the physicians' smoking habit, their clinical practice in offering a smoking cessation intervention to patients who smoke, and the training they received in this field.

METHODS

A Web-based survey was sent to 285 physicians.

RESULTS

The survey response rate was 75%. Sixty-two percent, 24%, and 14% of responders were never, former, and current smokers, respectively. Six percent of all responding physicians have already participated in smoking cessation training and 43% of them declared their willingness to be trained. Eighty-six percent of all responding physicians asked about the patients' smoking status, 50% routinely advised patients to quit smoking, and 32% assessed their motivation to do so. Smoking cessation guidelines were not followed mostly for lack of time, fear to increase patients' stress, and lack of smoking cessation training. Ninety-four percent of responding physicians knew the smoking cessation service for outpatients and 65% referred at least one patient, 66% of responding physicians knew the service for inpatients, and 36% of them asked for at least one intervention in the ward.

CONCLUSIONS

This study pointed out partial adherence of the physicians working in a leading cancer center to the smoking cessation guidelines. The clinicians' smoking habits did not influence the training and the clinical practice in offering patients smoking cessation interventions.

Patients' and healthcare professionals' views on a specialist smoking cessation service delivered in a United Kingdom hospital: a qualitative study

BACKGROUND

Hospital admission provides a powerful opportunity to promote smoking cessation. We explored patients' and healthcare professionals' (HCP) views of a specialist smoking cessation service comprising systematic smoking ascertainment, default provision of pharmacotherapy and behavioural counselling at the bedside, and post-discharge follow-up, in a clinical trial in a United Kingdom teaching hospital.

METHODS

Semi-structured interviews with 30 patients who were offered the intervention, and 27 HCPs working on intervention wards, were audio-recorded, transcribed verbatim and analysed using thematic analysis.

RESULTS

The shock of being admitted, and awareness that smoking may have contributed to the need for hospital admission, caused many patients to reassess their quit intentions. Most patients felt the service was too good an opportunity to pass up, because having long-term support and progress monitored was more likely to result in abstinence than trying alone. Had they not been approached, many patients reported that they would have attempted to quit alone, though some would have been discouraged from doing so by pharmacotherapy costs. Service delivery by a specialist advisor was favoured by patients and HCPs, largely because HCPs lacked time and expertise to intervene. HCPs reported that in usual practice, discussions about smoking were usually limited to ascertainment of smoking status. Timing of service delivery and improved co-ordination between service staff and inpatient ward staff were matters to address.

CONCLUSIONS

A hospital-based specialist smoking cessation service designed to identify smokers and initiate cessation support at the bedside was deemed appropriate by patients and HCPs.

TRIAL REGISTRATION

Trial registration: ISRCTN25441641.

Systematic identification and treatment of smokers by hospital based cessation practitioners in a secondary care setting: cluster randomised controlled trial

OBJECTIVES

To investigate the effectiveness of the systematic default provision of smoking cessation support to all adult smokers admitted to hospital, relative to usual care.

DESIGN

Open, cluster randomised controlled trial.

SETTING

Acute medical wards in one large teaching hospital in the United Kingdom.

PARTICIPANTS

264 patients randomised to intervention and 229 to usual care; primary outcome data were available at four weeks for 260 and 224 patients, respectively. All adult smokers and recent ex-smokers able to give informed consent were eligible for entry into the study.

INTERVENTIONS

The intervention comprised systematic smoking ascertainment and default provision of behavioural support and cessation pharmacotherapy for the duration of the hospital stay for all smokers and recent ex-smokers, with follow-up and referral to community services after discharge. Usual care comprised cessation support delivered at the initiative and discretion of clinical staff. All staff and patients were aware of group assignment.

MAIN OUTCOME MEASURES

Smoking cessation at four weeks, validated by measuring exhaled carbon monoxide. Secondary outcomes were uptake of inpatient behavioural support, use of cessation pharmacotherapy, referral to and uptake of community support after discharge, and validated smoking cessation at six months. Participants lost to follow-up were assumed to have reverted to smoking.

RESULTS

All patients in the intervention group received at least brief advice to quit smoking, compared to 106 (46%) patients in the usual care group. Cessation at four weeks was achieved by 38% (n=98) of intervention patients and 17% (n=37) of usual care patients (adjusted odds ratio 2.10 (95% confidence interval 0.96 to 4.61), P=0.06, number of patients needed to treat 8). Uptake of inpatient behavioural support, use of pharmacotherapy, and referral to and uptake of community support after discharge were all substantially and statistically significantly higher in the intervention group than in the usual care group. Cessation at six months was achieved by 19% (n=47) of intervention and 9% (n=19) of usual care patients, although this difference was not significant (adjusted odds ratio 1.53 (95% confidence interval 0.60 to 3.91); P=0.37).

CONCLUSIONS

Substantial improvements in smoking cessation among smokers admitted to hospital can be achieved by systematic ascertainment and delivery of cessation support in secondary care.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Number ISRCTN25441641.

Spanish primary health care nurses who are smokers: this influence on the therapeutic relationship

AIM

To identify the perception of Primary Health Care (PHC) female nurses in the Balearic Islands in Spain who are smokers, regarding the suitability of their anti-smoking therapeutic relationships with their clients. Also, to identify what factors they consider may determine why nurses smoke less in PHC than in specialized care (SC).

BACKGROUND

Backed by the signing of the WHO Framework Convention on Tobacco Control (WHO FCTC), a new Anti-Smoking law has been in force in Spain since 2006. This legislation limits the places where tobacco may be consumed. PHC nurses, because of their professional abilities, their number and their direct contact with society on all accounts - both health- and illness-wise - and also because of the proven efficacy of their interventions in the fight against the smoking habit, are called upon to play an important role against the smoking habit in the 21st century.

METHOD

A qualitative study using a semi-structured interview with 15 PHC female nurses who are smokers.

FINDINGS

Regarding the therapeutic relationship, basically two attitudes are adopted: first, blaming themselves and feeling uncomfortable and inadequate to be able to help someone to give up smoking or, second, considering themselves to be in an optimum situation in which to be able to help by sharing their addiction and thereby understanding and empathizing much more with clients. PHC nurses believe they smoke less than SC nurses as a result of a greater degree of awareness.

CONCLUSION

We would suggest that SC nurses should acquire a more relevant role in the fight against the smoking habit. In light of their capacity, commitment and efficacy, we believe there is a case for total autonomy as far as their role as therapists in breaking smoking habits is concerned.