Promoting Smoking Cessation

Transcription

1 Smoking cessation education for surgical residents: challenges in driving change Promoting Smoking Cessation Author: Gilgamesh Eamer MD Date: October 1, 2016

2 I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization. Je n ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d appareils médicaux ou un cabinet de communication. 2

3 Background 1 in 5 North Americans smoke regularly Smoking contributes to 1 in 5 deaths Number one cause of premature death Smoking cessation by a physician can decrease risk of death 15% of all practicing physicians are residents CanMEDS health advocate pillar Smoking cessation is a key intervention 3

4 Smoking cessation interventions Resident smoking cessation interventions Are shown to increase abstinence Are inconsistently performed Are less commonly performed by surgical residents Smoking cessation interventions are not uniformly taught by residency programs 4

5 Previous findings Surgical residents are just as likely to ask about smoking Less follow-up on readiness to quit Less likely to give patients advice on how to quit Surgical residents are More likely to say smoking interventions aren t their job More likely to say the don t have time More likely to witness smoking cessation counseling while offservice Turner SR, Lai H, Bédard ELR. Smoking cessation counselling by surgical and nonsurgical residents: Opportunities for health promotion education. Surgical Education. 2014:

6 Our intervention Provided 90-minute smoking intervention training by addictions specialist PowerPoint and multimedia based session Sub-specialty specific indications for intervention addressed Information from AlbertaQuits provided 8 accredited surgical residency programs 6

7 Study design Pre-intervention survey and follow-up surveys at 6 weeks and 6 months Demographic data Age and gender Surgical training program Years of training Combination of 5-point Likert scales and open ended responses Questions repeated in all three surveys Survey linked anonymously 7

8 Survey questions Smoking cessation training history Current counseling technique Frequency of smoking history and cessation interventions Available resources and role models The residents role in cessation counseling 8

9 Compared to 2012 In 2012 more surgical residents felt: They should perform smoking cessation interventions There were smoking cessation role models in their specialty Pre-intervention Mean SD Variance n Mean SD Variance n p I regularly give patients advice about how to quit smoking Counseling patients about smoking cessation is part of my job as a resident Smoking cessation counseling is not my job I don't have time to counsel patients about quitting smoking Formal teaching about how to counsel patients effectively Role models in my specialty who demonstrate how to counsel patients effectively Educational materials available to distribute to patients

10 Following intervention There were no differences between post-intervention and 2012 surveys Post-intervention Mean SD Variance n Mean SD Variance n p Counseling patients about smoking cessation is part of my job as a resident Smoking cessation counseling is NOT my job I don't have time to counsel patients about quitting smoking Formal teaching about how to counsel patients effectively Role models in my specialty who demonstrate how to counsel patients effectively Educational materials available to distribute to patients

11 Demographics 8 surgical residency programs represented General surgery and orthopedics most common Majority of respondents are PGY1 or % of respondents were male Most respondents aged

12 Pre-intervention data Cessation counseling is uncommon Residents feel cessation counseling is important but aren t doing it themselves 12

13 Pre-intervention data What is your level of agreement with the following statements? Would the following increase your tendency to counsel patients? Pre-intervention Mean SD Variance n Counseling patients about smoking cessation is part of my job as a resident? Formal teaching about how to counsel patients effectively Role models in my specialty who demonstrate how to counsel patients effectively Educational materials available to distribute to patients Recognition of my counseling efforts by my program I DO NOT have enough time to perform smoking cessation interventions I have NOT had adequate training to conduct smoking cessation counseling Smoking cessation counseling IS part of my job A brief intervention from myself WILL have a significant effect I DO NOT have enough role models in my program to help me learn about smoking cessation Asking patients about smoking was strongly endorsed Most respondents were neutral or agreed with most statements 13

14 Techniques used by residents Most residents did not respond to the open ended question Common techniques include NRT Describing surgical impacts Pre-intervention Current technique Count NRT 12 5 As technique 2 encouragement 4 Assess readiness to quit 7 Educate about risks 5 Describe surgical impacts 14 refer to GP 2 Nothing/no response 31 Pharmacologic 2 6-week post intervention Current technique Count NRT 0 5 As technique 0 encouragement 0 Assess readiness to quit 0 Educate about risks 0 Describe surgical impacts 0 refer to GP 0 Nothing/no response 32 Pharmacologic 0 6-month post intervention Current technique Count NRT 3 encouragement 2 Assess readiness to quit 6 Educate about risks 2 Smoke free environment 2 Describe surgical impacts 6 refer to GP 2 Refer to AlbertaQuits 2 Nothing/no response 20 Pharmacologic 2 14

15 6-week follow-up What is your level of agreement with the following statements? Would the following increase your tendency to counsel patients? Before Post 6-week Unpaired t-test Mean SD Mean SD t p Counseling patients about smoking cessation is part of my job as a resident? >.10 Formal teaching about how to counsel patients effectively >.10 Role models in my specialty who demonstrate how to counsel patients effectively Educational materials available to distribute to patients Recognition of my counseling efforts by my program >.10 I DO NOT have enough time to perform smoking cessation interventions >.10 I have NOT had adequate training to conduct smoking cessation counseling Smoking cessation counseling IS part of my job >.10 A brief intervention from myself WILL have a significant effect I DO NOT have enough role models in my program to help me learn about smoking cessation >.10 Unpaired t-test Increased perception that smoking cessation intervention is effective 15

16 6-month follow-up What is your level of agreement with the following statements? Would the following increase your tendency to counsel patients? Before Post 6-month Paired T-Test Mean SD Mean SD t p Counseling patients about smoking cessation is part of my job as a resident? Formal teaching about how to counsel patients effectively >0.1 Role models in my specialty who demonstrate how to counsel patients effectively Educational materials available to distribute to patients >0.1 Recognition of my counseling efforts by my program I DO NOT have enough time to perform smoking cessation interventions >0.1 I have NOT had adequate training to conduct smoking cessation counseling <0.01 Smoking cessation counseling IS part of my job >0.1 A brief intervention from myself WILL have a significant effect >0.1 I DO NOT have enough role models in my program to help me learn about smoking cessation >0.1 Paired t-test - significant improvement in rolemodels and training No change in perception or performance of counseling 16

17 6-weeks 6-months Increased training p=0.06 Risk of response bias for this item 17

18 Conclusion There is minimal if any change in perception of smoking cessation among surgical residents between 2012 and 2015 Persistent improvement in perception that they have received adequate training Impression that smoking cessation interventions are effective was not durable over 6 months A single intervention improves some attitudes towards smoking cessation but the effects are not durable Concerted career-long educational programs may be necessary to change attitudes and practices 18

19 Future Research UBC arm started this week Low intervention rates 65% don t intervene 96% have not had training until this week Data analysis is ongoing 6-week and 6-month data collection planned 19

20 Acknowledgements Dr. E. Bédard Thoracic surgery, University of Alberta Dr. H Lai Dir. Assessment and Evaluation, University of Alberta Dr. K. Meador ARCH team, University of Alberta Dr. S. Turner Thoracic surgery fellow, Memorial Sloan Kettering Cancer Center Dr. J. Cha General surgery resident, University of British Columbia 20

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