The Physician’s Role in Smoking Cessation

Assessment of Communication Barriers in Community Pharmacies

This study identified previously reported facilitators and barriers to pharmacist-client communication and then evaluated their impact on the observed communication behaviors of pharmacists. Pharmacists (n = 100) completed a seven-page questionnaire collecting information on 11 variables that had been organized according to the Policy, Regulatory and Organizational Constructs in Educational and Ecological Development (PROCEDE) model as predisposing, enabling, or reinforcing of pharmacist communication with their clients. Demographic variables also were included. “Communication quality” served as the study’s dependent variable, whereas pharmacist responses served as the independent variables. Communication quality scores for each pharmacist were obtained from the analysis of 765 audio recordings of verbal exchanges occurring between the study pharmacists and their consenting clients during 4-hour, on-site observation periods. Four of the variables examined in the study were found to share a unique relationship with communication quality (pharmacists’ attitude, year of graduation, adherence expectations, and outcome expectations). Hierarchical multiple regression analysis revealed that the variables measured in the questionnaire accounted for 23% of the variance in communication quality scores. Plausible explanations for why the study was unable to capture more of the variance in its proposed relationships and future areas for research are provided.

The importance of tobacco cessation training for nurses in Serbia

BACKGROUND

This study assessed smoking prevalence, attitudes, and perceived patient counseling responsibilities among practicing nurses in Serbia. The need for nurses to receive tobacco cessation training is explored.

METHODS

Data were collected through a cross-sectional survey of 230 nurses at public institutions in Belgrade, a health care center in Belgrade, and public health care facilities throughout Serbia.

RESULTS

The smoking prevalence was 52% for male nurses and 47% for female nurses. Nurses had the greatest mean level of agreement with statements about controlling smoking through policy, followed by statements about being role models. Only 15% (n = 35) of nurses regularly counseled their patients about smoking, and only 16% of nurses (45% of males vs. 12% of females, p < .0001) had received training in counseling patients about smoking. Nurses' training in counseling patients about smoking was positively associated with the nurses' belief that their counseling could help patients stop smoking or never start smoking. In addition, nurses with training in counseling patients about smoking considered themselves significantly better prepared to assist patients to quit smoking. Nurses who smoked were significantly less likely to believe that their counseling about smoking could be effective. They also felt significantly less well prepared to assist patients to quit smoking.

CONCLUSION

These findings show that nurses' training in tobacco cessation counseling results in greater self-perceived confidence and frequency of regular tobacco cessation counseling in Serbia.

Nursing interventions for smoking cessation

BACKGROUND

Healthcare professionals, including nurses, frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions.

OBJECTIVES

To determine the effectiveness of nursing-delivered smoking cessation interventions.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group specialized register and CINAHL in July 2007.

SELECTION CRITERIA

Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow up of at least six months.

DATA COLLECTION AND ANALYSIS

Two authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed effect model and reported the outcome as a risk ratio (RR) with 95% confidence interval (CI).

MAIN RESULTS

Forty-two studies met the inclusion criteria. Thirty-one studies comparing a nursing intervention to a control or to usual care found the intervention to significantly increase the likelihood of quitting (RR 1.28, 95% CI 1.18 to 1.38). There was heterogeneity among the study results, but pooling using a random effects model did not alter the estimate of a statistically significant effect. In a subgroup analysis there was weaker evidence that lower intensity interventions were effective (RR 1.27, 95% CI 0.99 to 1.62). There was limited indirect evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non-hospitalized patients also showed evidence of benefit. Nine studies comparing different nurse-delivered interventions failed to detect significant benefit from using additional components. Five studies of nurse counselling on smoking cessation during a screening health check, or as part of multifactorial secondary prevention in general practice (not included in the main meta-analysis) found nursing intervention to have less effect under these conditions.

AUTHORS' CONCLUSIONS

The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses to patients, with reasonable evidence that intervention is effective. The evidence of an effect is weaker when interventions are brief and are provided by nurses whose main role is not health promotion or smoking cessation. The challenge will be to incorporate smoking behaviour monitoring and smoking cessation interventions as part of standard practice, so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and/or counselling to quit along with reinforcement and follow up.

Smoking Cessation for Women: Evidence of the Effectiveness of Nursing Interventions

The association between cigarette smoke and disease is direct; cigarette smoking is a major cause of disease in the United States. More than 400,000 people die each year as a result of cigarette smoke. Smoking is responsible for almost 90% of all cases of lung cancer. Smoking cessation reduces the risk of lung cancer within five years. Cessation also may reduce the risk of other cancers, such as cancer of the head and neck, pancreas, and esophagus. Smoking causes skin wrinkling and sexual dysfunction, which can be mediated by smoking cessation. Even after a diagnosis of cancer, smoking cessation improves the odds of survival and reduces the risk of developing a second cancer.

Nursing interventions for smoking cessation

BACKGROUND

Health care professionals, including nurses, frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions.

OBJECTIVES

To determine the effectiveness of nursing-delivered smoking cessation interventions.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group specialized register and CINAHL in June 2003.

SELECTION CRITERIA

Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow-up of at least six months.

DATA COLLECTION AND ANALYSIS

Two authors extracted data independently.

MAIN RESULTS

Twenty-nine studies met the inclusion criteria. Twenty studies comparing a nursing intervention to a control or to usual care found the intervention to significantly increase the odds of quitting (Peto Odds Ratio 1.47, 95% CI 1.29 to 1.68). There was heterogeneity among the study results, but pooling using a random effects model did not alter the estimate of a statistically significant effect. There was limited evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non-hospitalized patients also showed evidence of benefit. Five studies comparing different nurse-delivered interventions failed to detect significant benefit from using additional components. Five studies of nurse counselling on smoking cessation during a screening health check, or as part of multifactorial secondary prevention in general practice (not included in the main meta-analysis) found the nursing intervention to have less effect under these conditions.

REVIEWER'S CONCLUSIONS

The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses to patients, with reasonable evidence that interventions can be effective. The challenge will be to incorporate smoking behaviour monitoring and smoking cessation interventions as part of standard practice, so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and/or counselling to quit along with reinforcement and follow-up.

Non-primary care physicians and smoking cessation counseling: Women Physicians' Health Study

OBJECTIVES

The Women Physicians' Health Study (WPHS) offers a unique opportunity to examine the counseling and screening practices of women physicians in various specialties. In this study we describe the prevalence of self-reported counseling on smoking cessation among non-primary care women physicians and examine the association between their demographic, professional, and personal characteristics and such counseling on smoking cessation.

METHODS

Conducted in 1993-1994, WPHS is a nationally representative cross-sectional mailed survey of U.S. women physicians with 4,501 respondents representing all major specialties. Physicians in 9 specialty areas were grouped in 6 categories: (1) anesthesiology; (2) general surgery and surgical subspecialties; (3) emergency medicine; (4) medical subspecialties; (5) psychiatry; and (6) other. Frequent counseling was defined as having counseled patients who were known smokers at every visit or at least once a year.

RESULTS

Overall, 45% of the physicians frequently counseled smokers to quit. Medical subspecialists (80%) were most likely and psychiatrists (29%) least likely to counsel frequently. Specialty, perceived relevance of counseling to the physician's practice, and self-confidence in counseling about smoking cessation were associated with frequent counseling.

CONCLUSION

Cessation counseling by non-primary care physicians can reduce tobacco-related morbidity and mortality. Increasing perceived relevance and self-confidence among this group of physicians, combined with implementation of system changes and the creation of physician accountability can facilitate the provision of such counseling.

Smoking cessation counseling by primary care women physicians: Women Physicians' Health Study

OBJECTIVES

The Women Physicians' Health Study (WPHS) offers a unique opportunity to examine the counseling and screening practices of women physicians. The objectives of this study were to: describe the prevalence of self-reported smoking cessation counseling among primary care women physicians and determine the association between physician demographic, professional, and personal characteristics and smoking cessation counseling.

METHODS

Conducted in 1993-1994, WPHS is a nationally representative cross-sectional mailed survey of U.S. women physicians and included 4,501 respondents representing all major specialties. Primary care physicians included 5 specialty areas and were grouped into 3 categories: (1) general primary care; (2) obstetrics/gynecology (ob/gyn); and (3) pediatrics. Frequent counseling was defined as having counseled patients who were known smokers at every visit or at least once a year.

RESULTS

Women physicians in general primary care (84%) and ob/gyn (83%) were more likely to frequently counsel their patients about cessation than were pediatricians (41%). Perceived relevance of counseling to a physician's practice was significantly associated with frequent counseling. Personal characteristics (current smoking status, personal or family history of a smoking-related disease, or living with a smoker as an adult or child) were not significantly correlated with counseling.

CONCLUSION

The majority (71%) of physicians reported frequently counseling their patients. However, there was significant variation by physician specialty. In addition, perceived relevance of counseling was strongly associated with counseling behavior. Physician counseling on cessation can reduce tobacco-related morbidity and mortality. Increasing perceived relevance, implementing system changes, and creating accountability can facilitate cessation counseling by physicians.

The pediatrician's role in reducing tobacco exposure in children

OBJECTIVE

Pediatricians have a unique and important role to play in the prevention and treatment of childhood and adolescent tobacco use, the protection of patients from the harmful effects of environmental tobacco smoke, and the encouragement of smoking cessation among parents. However, because recent research indicates that physician training in tobacco dependence is woefully weak and lacks a model for training, this article constructs a useful approach to this problem.

METHODOLOGY

A comprehensive review of the literature served as the basis for the development of a new model for pediatrician training in tobacco dependence.

RESULTS

A comprehensive model is presented for training pediatricians in the areas of reducing infant and child exposure to environmental tobacco smoke, preventing youth smoking initiation, and providing smoking cessation assistance for adolescents and parents.

CONCLUSIONS

Pediatricians have been called on to play an active role in the antitobacco arena. Because of their unique opportunity to interact with children, adolescents, and parents, pediatricians can and should be antitobacco interventionists. For this to occur, however, additional guidance should be provided to pediatricians during their training to better prepare them to carry out effective assessment and intervention practices. smoking initiation, smoking prevention, smoking cessation, environmental tobacco smoke, pediatricians.

Nursing intervention and smoking cessation: A meta-analysis

OBJECTIVE

To determine with meta-analysis the effects of nursing-delivered smoking cessation interventions.

RESULTS

Fifteen studies comparing nursing intervention with a control or usual care found intervention to significantly increase the odds of smoking cessation. There was heterogeneity among the study results, but pooling by using a random effects model did not alter the estimate of effect. There was no evidence from indirect comparison that interventions classified as intensive had a larger effect than less intensive ones. There was evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in nonhospitalized patients also showed evidence of efficacy. Nurse counseling on smoking cessation during a screening health check was likely to have less effect. The results indicate the potential benefits of smoking cessation advice and counseling given by nurses to their patients, with reasonable evidence that intervention can be effective.

Physician advice and tobacco use: a survey of 1st-year college students

First-year college students were surveyed by telephone to determine their current level of tobacco use and find out what advice they had previously received from physicians regarding tobacco products. Current tobacco use reported in this 1st-year population was 19% in men and 17% in women. Although 99.6% of the students reported having had a medical visit within the last 5 years and 89% reported a visit within the past 12 months, only 26% remembered being asked at the last visit about their use of tobacco. Women were significantly more likely than men to have been asked about tobacco (31% compared with 21%), perhaps because of oral contraceptive counseling and the women's medical history. It appeared that healthcare providers are not fully using the opportunities available to them to educate young adults about using tobacco.

Physician recommendations for dietary change: their prevalence and impact in a population-based sample

A random-digit-dialing survey to examine the prevalence, content, and impact of physician dietary recommendations in a representative population-based sample of Washington State residents was administered to 1972 persons aged 18 years and older. Twenty percent of those surveyed received a physician's recommendation for dietary change in the previous year. The most common recommendations were to decrease intake of cholesterol, calories, and red meat and to increase intake of vegetables and fiber. Respondents receiving recommendations were more likely to report decreased use of high-fat foods and increased use of high-fiber foods and to be in the maintenance stage of dietary change. Results suggest that physicians can play a limited role in promoting dietary change.