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Smoking cessation counseling: a missed opportunity for general surgery trainees
William C Krupski1, Hai T Nguyen, Darrell N Jones
1Division of Vascular Surgery, Department of Surgery, University of Colorado Health Sciences Center, Denver, CO 80262, USA. William.Krupski@uchsc.edu
Purpose:
The purpose of this study was to evaluate and compare the attitudes, practices, technique utilizations, and barrier perceptions of smoking cessation counseling (SCC) in general surgery (GS) and primary care (PC) residents.
Methods:
One hundred house staff officers (45 GC and 55 PC residents, consisting of internal medicine and family medicine disciplines) were randomly surveyed. chi(2) and t tests were used for comparative analysis where appropriate. The National Cancer Institute's recommendation that physicians follow the "four A's" for SCC (Ask, Advise, Assist, and Arrange follow-up) was examined with respect to compliance by surgical and medical residents.
Results:
Fewer GS than PC residents thought physicians were responsible for SCC (64% versus 85%; P <.02), and fewer felt well prepared to counsel their patients (38% versus 58%; P <.05). Nevertheless, about 85% of both groups reported a higher inclination to provide SCC to patients who expressed an interest for cessation. Although many GC residents Ask (89% GS versus 100% PC residents; P <.03) and Advise (64% versus 89%; P <.003) new patients about smoking, they did so less frequently than PC residents. GC residents used fewer SCC techniques than did PC residents (3.96 versus 6.00; P <.001) and Arranged fewer follow-up visits for SCC (7% versus 44%; P <.001). Postgraduate year did not correlate with SCC in either GS or PC residents. Residents from both groups perceived time constraints, lack of patient desire, and poor patient compliance to be the main barriers in SCC.
Conclusion:
In this study, many GC residents agreed that physicians were responsible for SCC, but few followed through by arranging SCC follow-up visits compared with their PC resident counterparts. Behavior does not appear to change as residents mature, despite greater exposure to smoking-related diseases. In every dimension of SCC studied, GS residents played a less assertive role when compared with PC residents. GC residents should be more proactive in SCC because the diseases they treat are often related to cigarette smoking.