What keeps healthcare professionals from advising their patients who smoke to quit? A large-scale cross-sectional study
 
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Leiden University Medical Center, Public Health and Primary Care, Netherlands
Publication date: 2018-03-01
 
Tob. Induc. Dis. 2018;16(Suppl 1):A514
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ABSTRACT
Background:
Quit-advice provided by healthcare professionals effectively increases quit rates. Tobacco dependence treatment guidelines therefore recommend providing quit-advice to all patients who smoke (PWS), however, many healthcare professionals do not advise PWS to quit. This results in worse patient outcomes and higher healthcare costs. We examined determinants of providing quit-advice among a large sample of healthcare professionals from different fields, most of which have not been included in research on tobacco discouragement before.

Methods:
Online survey among addiction specialists (n=13), anaesthesiologists (n=61), cardiologists (n=23), dental hygienists (n=74), dentists (n=40), general practitioners (n=149), internists (n=79), midwives (n=82), neurologists (n=29), ophthalmologist (n=25), paediatricians (n=42), pulmonologists (n=121), surgeons (n=65), youth specialists (n=78) and other physicians (n=74). Provision of quit-advice, and socio-cognitive determinants of and environmental/patient barriers to using the Dutch Tobacco-dependence-guideline were assessed (entire sample), as well as perceptions of smoking (subsample).

Results:
Most participants (27%) advised the majority of PWS to quit, but only 16% advised all of them to quit and 18% advised none to quit (16% half, 24% minority). Midwives were most likely to advise all PWS to quit (42%). Multivariate logistic regression analysis (n=760) showed that providing quit-advice (to all/majority vs. half/minority/none of PWS) was significantly associated with stronger intentions to use the guideline, stronger role perceptions, and sufficient training in smoking-cessation-care. Those who mentioned lack of reimbursement as a barrier to providing smoking-cessation-care were more likely to provide quit-advice, possibly because particularly those who are more involved in tobacco treatment experience reimbursement as a barrier. Furthermore, participants who perceived continuing smokers to lack willpower were less likely to provide quit-advice (n=446).

Conclusions:
Quit-advice is provided less often than recommended. This may be improved by training, and by making healthcare professionals more aware of their role in tobacco discouragement, and the role of addiction (vs. willpower) in continued smoking.

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