Abstract
Hospitalization is an opportune time for smoking cessation support; cessation interventions delivered by hospital physicians are effective. While general practitioners' and outpatients' knowledge and attitudes towards smoking cessation have been studied in great detail, in-patient cessation programmes have received less attention. Questionnaire-based survey of a convenience sample of hospital physicians and in-patients at Göttingen University Hospital, Germany. All 159 physicians directly involved in bedside care on medical and surgical wards received a three-page questionnaire examining smoking status, knowledge of smoking-attributable morbidity and mortality, and their understanding of the effectiveness of methods to achieve long-term smoking cessation. Perceived barriers to the delivery of counselling and cessation services to smoking patients were identified. One thousand randomly selected patients on medical (N = 400) and surgical (N = 600) wards were invited to complete a similar questionnaire. Seventy-seven physicians (response rate 48.4%) and 675 patients (67.5%) completed the questionnaire. Patients and physicians alike underestimated the smoking-attributable risk of developing smoking-related cancers and chronic obstructive lung disease. In addition, severe misperceptions regarding the effectiveness of cessation methods were noted in both populations with 'willpower' being thought to be most effective in achieving abstinence. Only one-third of smoking patients recalled having been counselled to quit. Physicians identified lack of time as a central barrier to counselling smoking patients. These findings suggest that hospitalized smokers in a large German university hospital might not be treated according to international guidelines.
Highlights
Decreasing smoking prevalence is among the most effective interventions to reduce morbidity and mortality.[1]
While there was no difference in the proportion of female patients in both samples (45.8% and 50.6%, respectively), patients treated on medical wards were significantly older than those on surgical wards
Just over half (50.6%) of all 223 smoking patients scored an FTND value > 5, indicating a high level of nicotine dependence; a similar proportion (50.2%) stated that they wished to give up smoking
Summary
Decreasing smoking prevalence is among the most effective interventions to reduce morbidity and mortality.[1]. While the primary care physician’s role in counselling smoking patients is well accepted, advising hospitalized smokers to quit is important.[4] Many hospitalized patients are admitted as a consequence of smoking-related disease, and hospitalization provides a unique opportunity to identify smokers and initiate a cessation attempt.[5] Such interventions can dramatically reduce rates of readmission and all-cause mortality.[6] Very few studies have assessed the extent to which hospitalized patients are being screened for their smoking status and, when appropriate, being provided with adequate cessation advice and support. Methods: All 159 physicians directly involved in bedside care on medical and surgical wards received a three-page questionnaire examining smoking status, knowledge of smoking-attributable morbidity and mortality, and their understanding of the effectiveness of methods to achieve long-term smoking cessation. Conclusions: These findings suggest that hospitalized smokers in a large German university hospital might not be treated according to international guidelines
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