Physician smoking cessation counseling and adherence to the Clinical Practice Guideline

Abstract

Objective The U.S. Public Health Service Clinical Practice Guideline recommends that physicians provide tobacco cessation interventions to their patients at every visit. While many studies have examined the extent to which physicians implement the guideline's “5 A's”, few studies have examined the extent to which physicians implement the guideline's “5 R's” which are to be used in a Motivational Interviewing (MI) consistent style with smokers not ready to quit. This study examined the extent to which physicians in usual practice and without specific training administered the 5 R's including the use of an MI style. Methods Thirty-eight physicians were audio recorded during their routine clinical practice conversations with smokers.Recordings were coded by independent raters on the implementation of each of the 5 A's, 5 R's and MI counseling style. Results Results revealed that for patients not ready to quit smoking, physicians most frequently discussed the patient's personal relevance for quitting and the risks of smoking. Roadblocks and rewards were discussed relatively infrequently. MI skill code analyses revealed that physicians, on average, had moderate scores for acceptance and autonomy support, a low to moderate score for collaboration and low scores for empathy and evocation. Conclusion Results suggest that for the Clinical Guideline to be implemented appropriately physicians will need specialized training or will need to be able to refer patients to counselors with the necessary expertise. Counseling efforts could increase providers’ willingness to implement guideline recommendations and therefore to enhance the person-centeredness of clinical care.

A qualitative assessment of provider perspectives on smoking cessation counselling

“…Participants were also from a single academic safety-net hospital so the views offered may not generalize to doctors in settings. Finally, doctor reports of their behaviour may not correspond with their actual behaviour; however, their descriptions were consistent with our prior observational study of their counselling efforts [17].…”

“…Results clearly indicate that patients are unlikely to receive highquality, evidence-based counselling for smoking cessation despite doctors generally believing in its importance. Although recent changes have required medical schools to include basic patientprovider communication skills in their curricula [26,30], most practising doctors have not received this training [17,31]. Only three doctors (21%) who participated in this study reported having formal training on smoking cessation counselling.…”

E‐cigarettes and the clinical encounter: Physician perspectives on e‐cigarette safety, effectiveness, and patient educational needs

“…Since at least 70% of smokers visit their physician annually, clinical encounters present an opportunity to assess e‐cigarette use among smokers and provide them with evidence‐based information about e‐cigarettes, in addition to following clinical practice guidelines for treating tobacco use and dependence . A large body of research has assessed physician compliance with the US Public Health Service (USPHS) tobacco cessation clinical practice guidelines and approaches to smoking cessation counselling more generally; however, research on physicians' approaches to discussing e‐cigarettes with their patients is limited. Indeed, the USPHS provides clinical practice guidelines for treating tobacco use and dependence, but it does not include guidelines on providing information about e‐cigarettes.…”

Awareness of patients with multiple sclerosis in Saudi Arabia regarding the relationship between smoking and multiple sclerosis

“…The clinical guideline emphasized the importance of referring smokers in general to a specially trained physician. 24 Research into patients' perceptions of doctors' advice to quit smoking revealed why some patients had not been counseled by their physician, and the fact that physicians feel that there is not enough time during their shifts to have this conversation about cessation. A criticism of this inference is that it takes only a few minutes to provide this advice.…”