Barriers Prevent Providers From Helping Patients Quit Smoking

Nurse practitioners (NPs) and physician assistants (PAs) have more opportunities to provide smoking cessation assistance than those in other positions but require more education on e-cigarettes and effective cessation methods to do so, according to a study published in Public Health in Practice.

Despite the availability of effective smoking cessation treatments, most smokers do not use them. The researchers noted that health care providers can motivate patients to quit smoking by educating them on its dangers, administering treatments, and providing smoking cessation services, and they identified various barriers preventing treatment facilitation, including mixed knowledge of e-cigarettes.

Because of this, the researchers investigated how cessation practices of oncologists, primary care physicians (PCPs), NPs, and PAs related to previously researched variables preventing the provision of cessation treatment in clinical settings. These variables included barriers to providing evidence-based cessation treatments and attitudes toward the prevalence and/or harms of tobacco use.

The researchers created a study population representative of each position. To do so, they set up quotas for age, gender, and geographic information obtained through public reports from medical institutions. The researchers only included PCPs, NPs, and PAs practicing in family/general practice or internal medicine and oncologists treating patients with cancers where smoking is a significant contributing factor; all participants also had to spend at least 20 hours per week in patient care activities.

Aiming to achieve a sample size of 450, the researchers sent 7881 invitation emails. Overall, they recruited 459 clinicians between August 8, 2018, and August 28, 2018. The respondents consisted of 151 oncologists, 150 PCPs, 98 NPs, and 60 PAs.

hand holding lit cigarette | Image credit: vchalup - stock.adobe.com.

Through the survey, the researchers discovered 4 common barriers across specialties. Seventy percent endorsed “patient doesn’t want to quit, and it is their decision”; 50% endorsed “smoking is not the reason for patient’s visit; must treat the immediate problem first”; 43% endorsed “patient wants to quit on their own”; and 32% endorsed “lack of effective methods available.” Also, most providers labeled themselves as “not very” and “somewhat” knowledgeable of e-cigarettes (M = 1.6 on a scale from 0-3).

The survey determined that those providing in-house cessation treatment with follow-up were more comfortable treating patients’ smoking (β=.22;P≤.0001); PCPs and Pas used this treatment method more frequently. Also, the researchers associated a greater use of referrals to external quitting services and tools with greater perceived knowledge of e-cigarettes (β=0.28, P ≤.0001), oncologists engaging in this practice most often.

Additionally, the survey showed those who discussed patients’ use of e-cigarettes had a greater comfort treating patients’ smoking (β=0.15;P≤ .001)and a greater perceived knowledge of e-cigarettes (β=0.32;P≤ .0001); NPs and PAs more frequently engaged in this. Also, there was a greater frequency of discussing patients’ cigarette use in those with a greater comfort treating patients’ smoking (β=0.26;P≤ .0001); NPs mostly fell under this category. Lastly, the researchers associated discussing smoking risks and quitting benefits with those who have greater comfort treating patients’ smoking (β=0.16; P≤.001) and those less aware of free smoking cessation telephone counseling (β=–0.19;P ≤ .0001).

The researchers acknowledged their study’s limitations, one being its reliance on respondents’ self-reported cessation practices. They explained that this may be subject to social desirability biases, meaning that the respondents could have overstated how often they facilitate smoking cessation care.

Despite its limitations, the study helped researchers determine that additional education for oncologists, PCPs, NPs, and PAs is needed to learn more about e-cigarettes and effective smoking cessation interventions. They explained that this can help increase providers’ comfort with advising, assisting, and asking about patients quitting, resulting in more being helped.

In particular, NPs and PAs are “uniquely positioned to provide cessation assistance” due to the amount of time they spend with patients and their greater provision of cessation practices. Consequently, the researchers suggested they get more involved in cessation practices to help patients feel more comfortable receiving the treatment.

“Future efforts to increase their involvement in patient cessation care are likely to be fruitful, along with strategies to coordinate workflows for cessation services among providers in clinical practices,” the authors concluded.

Reference

Westmaas JL, Kates I, Makaroff L, Henson R. Barriers to helping patients quit smoking: lack of knowledge about cessation methods, E-cigarettes, and why nurse practitioners and physician assistants can help. Public Health Pract (Oxf). 2023;6:100409. doi:10.1016/j.puhip.2023.100409