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Standardized tool for assessing smoking cessation counselling of physicians needed

30 Dec 2016
The dilemma between stress relief and professional image for healthcare workers

Of the five strategies used to categorize self-reported counselling behaviour by physicians, “ask” and “advise” are the most commonly employed to control tobacco use among patients, a new meta-analysis reports.

However, because of the variation in how these behaviours are assessed, it is recommended to develop a standardized industry tool to better identify the shortcomings of the existing studies.

For the meta-analysis, the following databases were accessed: PsycINFO, Medline, Embase, Cochrane library and CINAHL. Studies that investigated the smoking cessation counselling by physicians were selected.

Some of the keywords used for the search were “primary care physician,” “smoking cessation” and “counselling.” To ensure all studies used the 5A strategy of categorization, only those that were published between 2000 and June 2015 were considered.

Two independent reviewers examined the titles and abstracts of the studies from the initial search. For inclusion, studies had to have measured the smoking cessation counselling activities as self-reported by physicians, and be in either English or German. Outcomes of these studies had to be the proportion of physicians who self-reported such activities. Studies that considered family physicians, general practitioners and internists in the population were also included.

On the other hand, studies that were focused only on young patients or reported the proportion of patients who had received counselling for the cessation of smoking were excluded from the final analysis.

From the studies, the following information were extracted: year and country of publication, authors, characteristics of the sample, the method of data collection employed and the outcomes of the study.  Self-reported counselling behaviours by physicians were categorized according to the 5A strategy: ask, advise, assess, assist and arrange.

Finally, the quality of each study included was assessed using the Mixed Method Appraisal Tool.

From the initial 3,491 records retrieved from the database, only 35 studies were included in the final analysis after applying the inclusion and exclusion criteria.

The analysis found that, on average, the counselling behaviours based on the 5A strategy were self-reported to be 65 percent for “ask,” 63 percent for “advise,” 36 percent for “assess,” 44 percent for “assist,” and 22 percent for “arrange.”

However, there was a high degree of variation in terms of the measures and items used to evaluate the counselling behaviours.

Overall, the findings show that, of the 5A strategy, only the first two – “ask” and “advise” – are commonly employed by physicians in counselling for cessation of smoking. This highlights the need for a standardized tool to evaluate such counselling behaviours.

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