A mixed-method systematic review and meta-analysis of mental health professionals' attitudes toward smoking and smoking cessation among people with mental illnesses

Abstract

Background and aimsPeople with mental illnesses and substance abuse disorders are important targets for smoking cessation interventions. Mental health professionals (MHPs) are ideally placed to deliver interventions, but their attitudes may prevent this. This systematic review therefore aimed to identify and estimate quantitatively MHPs attitudes towards smoking and main barriers for providing smoking cessation support and to explore these attitudes in‐depth through qualitative synthesis.MethodsThe online databases AMED, EMBASE, Medline, PsychINFO, HMIC and CINAHL were searched in March 2015 using terms relating to three concepts: ‘attitudes’, ‘mental health professionals’ and ‘smoking cessation’. Quantitative or qualitative studies of any type were included. Proportions of MHPs' attitudes towards smoking and smoking cessation were pooled across studies using random effects meta‐analysis. Qualitative findings were evaluated using thematic synthesis.ResultsThirty‐eight studies including 16 369 participants were eligible for inclusion. Pooled proportions revealed that 42.2% [95% confidence interval (CI) = 35.7–48.8] of MHPs reported perceived barriers to smoking cessation interventions, 40.5% (95% CI = 30.4–51.0) negative attitudes towards smoking cessation and 45.0% (95% CI = 31.9–58.4) permissive attitudes towards smoking. The most commonly held beliefs were that patients are not interested in quitting (51.4%, 95% CI = 33.4–69.2) and that quitting smoking is too much for patients to take on (38%, 95% CI = 16.4–62.6). Qualitative findings were consistent with quantitative results, revealing a culture of smoking as ‘the norm’ and a perception of cigarettes as a useful tool for patients and staff.ConclusionsA significant proportion of mental health professionals hold attitudes and misconceptions that may undermine the delivery of smoking cessation interventions; many report a lack of time, training and confidence as main barriers to addressing smoking in their patients.

Perceived barriers to smoking cessation among adults with substance use disorders

“…The belief that smoking cessation will interfere with efforts to attain or maintain sobriety is common among those with alcohol use disorder (Gulliver, Kamholz, & Helstrom, 2006; Martin, Rohsenow, MacKinnon, Abrams, & Monti, 2006). Moreover, beliefs that smoking cessation will interfere with SUD treatment may be reinforced by similar beliefs among some clinicians (Bobo, Slade, & Hoffman, 1995; Pagano, Tajima, & Guydish, 2016; Richter, 2006; Sheals, Tombor, McNeill, & Shahab, 2016), as well as limited availability of smoking cessation services in SUD treatment settings (Currie, Nesbitt, Wood, & Lawson, 2003; Knudsen, in press; Knudsen, Muilenburg, & Eby, 2013; Knudsen, Studts, Boyd, & Roman, 2010; Nahvi, Blackstock, Sohler, Thompson, & Cunningham, 2014). Thus, individuals presenting to SUD treatment have particularly poor smoking cessation rates and are vulnerable to a broader array of potential barriers to smoking cessation relative to those without SUDs, highlighting the importance of understanding barriers to smoking cessation in this population.…”

Attitudes of oncology healthcare practitioners towards smoking cessation: A systematic review of the facilitators, barriers and recommendations for delivery of advice and support to cancer patients

“…The themes extracted in this study agree with those seen in other healthcare scenarios. Sheals et al (2016) performed a systematic review of smoking cessation attitudes in mental health professionals where the most frequently perceived barriers were lack of knowledge or training followed by lack of time and low confidence 43 .…”

“…The authors found that approximately 40% of participants from all included studies held negative attitudes to cessation where practitioners believed patients were not interested in quitting smoking and that smoking cessation interventions were not effective 43 . Similarly, 38% of GPs view discussing smoking with patients as ineffective 44 .…”

An appraisal of practice guidelines for smoking cessation in people with severe mental illness

“…Smoking cessation guidelines for people with SMI also need to address practitioner barriers such as time and financial constraints and competing priorities in delivering smoking cessation (Sheals et al, 2016). Cost-effectiveness and affordability are particularly relevant for both practitioners and their patients, given that many smokers with SMI have limited incomes (Francke et al, 2008).…”