“Should I Give You My Smoking Lecture Now or Later?” Characterizing Emergency Physician Smoking Discussions and Cessation Counseling

Abstract

We determine frequency and manner in which emergency physicians address smoking with their patients. This was a descriptive secondary analysis of 871 audiotapes of physician-patient interactions collected during a trial assessing the effect of computer-based health risk assessment on emergency physician-patient communication. Consenting nonemergency female patients, ages 18 to 65 years, were enrolled from 2 socioeconomically diverse academic emergency department (EDs) for audiotaping of the ED visit. All audio files with any mention of smoking were independently coded with an in-depth structured coding form to characterize the nature of smoking-related discussions. Logistic regression was used to determine factors associated with emergency physician screening and discussion of tobacco exposure with women patients. Overall, 484 of 871 (56%) participants were verbally screened for smoking, with 156 of 484 (32%) disclosing current smoking, with similar incidence at both sites. Tobacco screening was higher (odds ratio 2.2; 95% confidence interval 1.3 to 3.5), whereas rates of smoking-related discussions were lower (odds ratio 0.41; 95% confidence interval 0.17 to 0.98) at the urban site. At both sites, physicians tended to screen and discuss smoking when patients presented with a health condition that could be aggravated by smoking. Only 56% of discussions with current smokers contained advice to quit, 16% included assessment of readiness to quit, and a minority (13%) included a referral. Physician empathy/encouragement was associated with patients' detailing quit attempts. Emergency physicians were likely to gather information about smoking but not to counsel or advise patients to quit. These results raise the question of whether emergency medicine resident training should include additional emphasis on smoking cessation counseling and motivational interviewing techniques.