Electronic cigarette communications between patients and physicians in the United States

Abstract

ImportancePhysicians play a primary role in smoking cessation, and their communication regarding e-cigarettes needs to be understood.ObjectiveTo examine physician-patient communication regarding e-cigarettes.DesignA national, repeated cross-sectional survey in 2018 and 2019 was conducted.SettingParticipants were invited by mail; surveys were completed online.ParticipantsResponse rates were 51.8% (2018) and 59.1% (2019), resulting in 2,058 board-certified physicians from family medicine, internal medicine, obstetrics/gynecology, cardiology, pulmonary/critical care, and hematology/oncology.ExposuresPhysician demographics, tobacco use, medical specialty, and harm-reduction beliefs (i.e., not all tobacco products equally harmful); two hypothetical clinical scenarios.Main outcomes and measuresPhysicians’ self-reported e-cigarette communication behaviors (being asked about e-cigarettes by patients and recommending e-cigarettes to patients), and hypothetical e-cigarette communication in two clinical scenarios.ResultsAmong 2,058 physicians, the mean age was 51.6 years and 41.5% were female. Over 60% of physicians believed all tobacco products are equally harmful. Overall, 69.8% of physicians reported ever being asked about e-cigarettes by their patients (35.9% in the past 30 days), while 21.7% reported ever recommending e-cigarettes to a patient (9.8% in the past 30 days). Pulmonologists (adjusted odds ratio [AOR], 2.14, 95% CI, 1.10-4.16) and cardiologists (AOR, 2.04; 95% CI, 1.03-4.05), as well as physicians who implemented the US Public Health Service Clinical Practice Guidelines (AOR, 1.77; 95% CI, 1.12-2.80) had greater odds of recommending e-cigarettes to patients. Physicians who endorsed a harm-reduction perspective (AOR, 3.04, 95% CI, 2.15-4.31) and had ever smoked cigarettes (AOR, 1.98; 95% CI, 1.27-3.08) were significantly more likely to recommend e-cigarettes. Being asked about e-cigarettes by patients was a strong predictor of physicians’ recommending (AOR,16.6; 95% CI, 10.3-26.7). In clinical scenarios, physicians were overall more likely to recommend e-cigarettes for cessation to an older, heavy smoker with multiple unsuccessful quit attempts than a younger, light smoker with no prior cessation treatments (49.3% vs. 15.2%, p<.001).Conclusions and relevanceFindings suggest physicians may recommend e-cigarettes for cessation under certain circumstances. Given the role of e-cigarettes in FDA’s comprehensive nicotine policy, there is need for continued physician education regarding e-cigarette efficacy, particularly correcting misperceptions regarding harm reduction.Key PointsQuestionHow do physicians communicate with their patients about e-cigarettes?FindingsIn this repeated cross-sectional survey of 2,058 respondents, physicians who were asked about e-cigarettes by their patients, endorsed a harm-reduction perspective, or had ever smoked were significantly more likely to recommend e-cigarettes to patients. Clinical scenarios showed physicians were significantly more likely to recommend e-cigarettes for an older, heavy smoker with prior unsuccessful quit attempts, and use of FDA-approved pharmacotherapy for a younger, light smoker with no prior cessation treatments.MeaningPhysicians may recommend e-cigarettes for cessation under certain circumstances, warranting continued physician education regarding e-cigarette efficacy.