Beliefs and Self-reported Practices of Health Care Professionals Regarding Electronic Nicotine Delivery Systems: A Mixed-Methods Systematic Review and Synthesis

Abstract

Aims This review explores the (1) beliefs and attitudes of health care professionals (HCPs) toward electronic nicotine delivery systems (ENDS) including use as a smoking cessation aid and/or harm reduction, safety and regulation, and (2) the extent and content of patient–HCP communication about ENDS. Methods PubMed, Embase, CINAHL, and PsycINFO were searched to identify articles published since 2003. The Mixed Methods Appraisal Tool and Strengthening the Reporting of Observational Studies in Epidemiology checklists were used to assess the quality of studies. Thematic synthesis was used to analyze qualitative data. Results A total of 45 articles (32 quantitative, 12 qualitative, and 1 mixed) were included. There was wide variation regarding beliefs about the efficacy of ENDS as a cessation aid. Although the majority of HCPs believes that ENDS are safer than combustible cigarettes, they also have concern about the short and long-term safety of ENDS, uptake by adolescents, and the potential for ENDS to act as a “gateway” to smoking cigarettes. Beliefs about ENDS are influenced by media stories and experiences provided by patients. Although most HCPs do not proactively recommend ENDS, they are more likely to support ENDS use among patients with smoking related comorbidities, heavy smokers with previous unsuccessful quit attempts, or patients who express interest in trying them. Conclusions Overall, HCPs hold diverse views about the efficacy of ENDS and expressed wariness over their potential health effects. HCP endorsement of ENDS use seems to depend largely on patient health status, the presence of other competing risk factors and patient preferences. Implication Although evidence on safety and efficacy of ENDS is emerging, HCPs should be honest with their clients, stating that the long-term safety is not yet established but what is known is that they appear to be a lower risk alternative to cigarettes. Our review highlights a need for further training and support for HCPs regarding ENDS use, which would enable them to guide their clients in making evidence-based decisions.

Nicotine vaping product use, harm perception and policy support among pharmacy customers in Brisbane, Australia

“…However, information sourced from the media and/or anecdotal experiences may be biased and could lead to confusion as the content may not be scientifically valid. The finding that few participants had received advice from a health-care professional about NVPs corroborates findings from a recent systematic review, which found health-care professionals do not engage in routine communication with patients regarding NVPs and other low risk alternatives to smoking [18]. Due to their geographic distribution and ease of accessibility, community pharmacies represent an ideal setting to educate the public and promote behaviours that improve health, one of which is smoking cessation.…”

Beliefs and practices regarding electronic cigarettes in smoking cessation among healthcare professionals in Slovenia

“…The majority of respondents in our study do not recommend or would not recommend ECs to their patients for smoking cessation or reducing the number of cigarettes smoked, consistent with other studies 8,9 and aligned with current recommendations in Slovenia. However, responses of those recommending ECs in other studies substantially differ, from none to a third or more 7,9,[18][19][20][22][23][24] .…”

“…In our study we found a notable difference in the range from around 6% to 13% and 14%. They would mostly recommend ECs in case of patients' queries and less likely proactively, as shown in other studies 8 . Other studies have shown that patient interest may be a significant promoter for a healthcare professional's recommendation 25 .…”

“…However, responses of those recommending ECs in other studies substantially differ, from none to a third or more 7,9,[18][19][20][22][23][24] . Differences in responses can be attributed to the actual diversity in healthcare professionals' practices, diversity in groups of healthcare professionals included in studies, their professional and workplace characteristics, beliefs, attitudes 8 , and also the result of differences in questions asked. In our study we found a notable difference in the range from around 6% to 13% and 14%.…”

“…Healthcare professionals' advice and counselling are important in shaping patients' decisions about ECs, but currently deal with limited data on their safety and effectiveness. Literature on healthcare professionals' communication and counselling about ECs to their patients, although limited, shows that a certain proportion of healthcare professionals recommend ECs for smoking cessation, but the majority do not 8,9 , which is aligned with the latest recommendations and guidelines from professional associations [10][11][12][13][14] . The Slovenia National Institute of Public Health's recommendations state that ECs should not be recommended for smoking cessation or reduction.…”