Lung cancer specialist physicians’ attitudes towards e-cigarettes: A nationwide survey

Abstract

ObjectivesDespite a sharp increase in e-cigarette use, there is debate about whether e-cigarettes are a viable alternative for harm reduction, and the forms that regulation should take. Healthcare providers can be effective in offering guidance to patients and their families and shaping regulatory policy. We described lung cancer specialists’ attitudes toward e-cigarettes and its regulation.MethodsWe undertook a nationwide survey of pulmonologists, thoracic surgeons, medical and radiological oncologists who are members of Korean Association for Lung Cancer. Survey items included beliefs and attitudes toward e-cigarettes, attitudes toward e-cigarette regulation and preparedness on discussing e-cigarettes with their patients.ResultsMost respondents believed that e-cigarettes are not safer than conventional tobacco cigarettes (75.7%) or smokeless tobacco (83.2%), and feared that discussing e-cigarettes with the patients would encourage use (65.4%). They did not consider it a smoking cessation treatment (78.3%), and thus would not recommend it to smokers who do not want to quit (82.2%) or who failed to quit with conventional smoking cessation treatment (74.1%). Most respondents supported all examples of e-cigarette regulations, including the safety and quality check (97.8%), warning label (97.8%), advertisement ban (95.1%), restriction of flavoring (78.4%), minimum purchasing age (99.5%), and restriction of indoor use (94.6%). Most learned about e-cigarettes from media and advertisements, or conversation with patients rather than through professional scientific resources, and reported discomfort when discussing e-cigarette with patients.ConclusionLung cancer specialist physicians in Korea doubt the safety of e-cigarette and use of e-cigarette as smoking cessation treatment, and supported strict regulation. However, only 20% reported that they obtained information on e-cigarettes from the scientific literature and many lacked adequate knowledge based on scientific evidence, suggesting the need for better preparedness. Nevertheless, the views of professionals revealed from our study could help to develop clinical guidelines and regulatory guidance.

Discussions between health professionals and smokers about nicotine vaping products: results from the 2016 ITC Four Country Smoking and Vaping Survey

“…Our findings also showed that just over half of the reported discussions about NVPs were initiated by the smokers themselves, and not by the HP, which may indicate that HPs do not feel entirely comfortable or confident bringing up the topic. This has also been found in other studies, where reasons for not advising about NVPs have included the HP's perceived uncertainty about the safety and efficacy of NVPs , negative beliefs , lack of knowledge , and lack of confidence in their own capacity to counsel smokers about NVPs . These cited studies, however, have mainly been conducted in the United States using convenience samples, with limited data on common practices in other countries.…”

“…Our findings showed that, overall, fewer than 10% of smokers reported having a discussion about NVPs with an HP in the last year. Moreover, a number of studies have shown that HPs are divided about recommending NVPs for smoking cessation . The results herein have shown that HPs rarely recommended NVPs to smokers (only 2% of smokers were encouraged to use an NVP, which was approximately a third among those who had a conversation about the topic).…”

“…The majority of research on HP–smoker discussions about NVPs comes from cross‐sectional and qualitative surveys of physicians. These studies have indicated that dialogues about NVPs have become increasingly frequent in clinical settings , are generally initiated by the patient , and typically do not end in a recommendation to use NVPs, apparently because most providers remain neutral or advise against use . To the best of our knowledge, only two studies have examined patient–physician NVP discussions from the patient's perspective .…”

Electronic cigarette use among patients with cancer: Reasons for use, beliefs, and patient‐provider communication

“…However, British public health organizations have taken a more encouraging stance on ECIGS as a harm reduction innovation that should be promoted for smoking cessation; consequently, the majority of British practitioners ask patients about ECIG use . Given the more conservative approach in the USA, it is possible that oncology providers fear that discussing ECIGS may implicitly encourage use of ECIGS …”

“…31 Given the more conservative approach in the USA, it is possible that oncology providers fear that discussing ECIGS may implicitly encourage use of ECIGS. 32 Because smoking can cause adverse cancer outcomes, it is critical for oncologists to assist their patients with smoking cessation and to educate patients about the risks and benefits of using ECIGS. Consistent with our participants' perceptions, a recent report from the National Academies of Sciences, Engineering, and Medicine concluded that ECIGS are far less harmful than cigarettes.…”