Abstract

Smoking tobacco has been identified as a prominent factor in the development of pulmonary disease, cardiovascular disease, and several cancers (e.g., lung and head/neck cancers). Although there is evidence that physicians can facilitate tobacco cessation using brief interventions, many implement cessation interventions inconsistently (Ellerbeck et. al., 2003). It has been found that tobacco cessation counseling significantly increases the likelihood that patients will stop using tobacco (Fiore, Bailey, Cohen, 2000). The current study utilized data from a sample of Kentucky physicians who completed a free continuing education program, Providers Practice Prevention: Treating Tobacco Use and Dependence, based on the recently published United States Public Health Service Clinical Practice Guideline. Prior to participating in the program, participants completed a survey of professional practices regarding tobacco cessation, which also included questions addressing attitudes toward and knowledge of tobacco cessation. Of the physicians who completed the survey (n = 356), most worked in a suburban setting, while years of experience (M=15.7, SD=11.1) and physician specialties varied greatly. Physicians strongly agreed that discussing tobacco use and encouraging tobacco cessation are important health issues for their patients. Furthermore, they demonstrated a respectable fund of knowledge related to tobacco use and cessation; however, physicians reported less confidence in their ability to treat tobacco use and nicotine dependence. While a large percentage of physicians reported that they ask their patients about tobacco use, far fewer reported that they subsequently assist their patients who are willing to quit. Only 46% of participants indicated that they “always” or “almost always” assist patients with the development of a tobacco cessation plan. In conclusion, it is clear that physicians need additional training regarding tobacco cessation. Based on these results, it is recommended that physicians receive additional tobacco cessation training as part of the medical school curriculum or continuing education programs. It is likely that applied training would provide the most benefit by targeting practical skill development, leading to increased comfort in discussing tobacco use and cessation and greater confidence in physicians’ abilities to treat nicotine dependence.

Introduction

• Approximately 440,000 deaths annually in the United States have been attributed to the use of tobacco (CDC, 2004).
  
• In 2001, 500 million individuals world wide were projected to die from their tobacco use (Tomar, 2001).
  
• It has been found that individuals who smoke and receive counseling on tobacco use have significantly higher quit rates then those who use tobacco and do not receive counseling (Ellerbeck, 2003).
  

Purpose

The primary goals of the current study were to examine:

• Physician attitudes and knowledge of tobacco use and cessation
  
• Physician practices regarding tobacco cessation strategies
  

Method

Sample Description (N = 356 physicians)

Gender:
Males (68%)
Female (32%)

Practice Specialty:
Family Practice (22%)
Internal Medicine (14%)
Ob/Gyn (8%)
Pediatrics (9%)
Other Medicine (47%)

Patient Base:
No patients - 3%
Rural - 38%
Suburb - 40%
Urban - 19%

Procedure

Physicians in Kentucky completed a free continuing education program, Providers Practice Prevention: Treating Tobacco Use and Dependence, based on the recently published United States Public Health Service Clinical Practice Guideline.

Measures

• Prior to participation in the educational program, participants completed a program survey of professional practices regarding tobacco cessation.
  
• The survey examined health care providers’ use of the 5 A’s: assess, ask, advise, assist, and arrange.
  
• The survey also included questions addressing attitudes toward and knowledge of tobacco cessation.
  

Results

• A vast majority of physicians strongly agreed that smoking cessation is important (97%), has negative health consequences (99%), and is a way of reducing morbidity/mortality (96%).
  
• However, physicians reported less confidence and insufficient knowledge about how to talk to their patients about nicotine dependence.
  
• Not many physicians felt comfortable in helping a patient develop a tobacco cessation plan. Only 46% of physicians indicated that they “always” or “almost always” assist patients with the development of a plan.
  
• Over half of physicians felt that they don’t have time to counsel their patients on tobacco cessation during visits. Furthermore, many physicians felt that tobacco cessation is not relevant for their patients who already use tobacco (50%).
  
• 49.6% of physicians had not heard of the Clinical Practice Guideline: Treating Tobacco Use and Dependence, and another 24% had not read it.
  
• Additionally, results indicated that only 28% of physicians reportedly assess a tobacco user’s willingness to quit at every visit.
  

Conclusions

• Based on these results, it is recommended that physicians receive additional tobacco cessation training as part of the medical school curriculum or continuing education programs.
  
• It is likely that applied training would provide the most benefit by targeting practical skill development, leading to increased comfort in discussing tobacco use and cessation and greater confidence in physicians’ abilities to treat nicotine dependence.
  

Limitations

• The sample was restricted to Kentucky physicians, and the results may not generalize to all physicians in the United States or abroad.
  
• In addition, results could be biased due to the fact that participants received continuing medical education credits for completing the program.