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Training physicians about smoking cessation

A controlled trial in private practices

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Abstract

Study objective:To test the hypotheses that physicians in private practice who receive a continuing education program (entitled “Quit for Life”) about how to counsel smokers to quit would counsel smokers more effectively and have higher rates of long-term smoking cessation among their patients.

Design:Randomized trial with blinded assessment of principal outcomes.

Setting:Private practices of internal medicine and family practice.

Subjects:Forty-four physicians randomly assigned to receive training (24) or serve as controls (20) and consecutive samples of smokers visiting each physician (19.6 patients per experimental and 22.3 per control physician).

Interventions:Physicians received three hours of training about how to help smokers quit. Physicians and their office staffs were also given self-help booklets to distribute to smokers and were urged to use a system of stickers on charts as reminders to counsel smokers about quitting.

Measurements and main results:Based on telephone interviews with patients, physicians in the experimental group were more likely to discuss smoking with patients who smoked (64% vs. 44%), spent more time counseling smokers about quitting (7.5 vs. 5.2 minutes), helped more smokers set dates to quit smoking (29% vs. 5% of smokers), gave out more self-help booklets (37% vs. 9%), and were more likely to make a follow-up appointment about quitting smoking (19% vs. 11% of those counseled) than physicians in the control group. One year later, the rates of biochemically confirmed, long-term (≥9 months) abstinence from smoking were similar among patients in the experimental (3.2%) and control (2.5%) groups (95% confidence interval for the 0.7% difference: −1.7 to +3.1%).

Conclusions:The authors conclude that this continuing education program substantially changed the way physicians counseled smokers, but had little or no impact on rates of long-term smoking cessation among their patients. There is a need for more effective strategies to help physicians help their patients to quit smoking.

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Authors and Affiliations

  1. the Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California

    Steven R. Cummings MD, Robert J. Richard MA, Carol L. Duncan MPH, Bruce Hansen PhD, Rachel Vander Martin MS & Thomas J. Coates PhD

  2. the Department of Epidemiology and International Health, University of California, San Francisco, California

    Steven R. Cummings MD & Thomas J. Coates PhD

  3. the School of Dentistry, University of California, San Francisco, California

    Barbara Gerbert PhD

  4. the Department of Clinical Psychology, Kaiser-Permanente Medical Group, Oakland, California

    Bruce Hansen PhD

Authors
  1. Steven R. Cummings MD
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  2. Robert J. Richard MA
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  3. Carol L. Duncan MPH
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  4. Bruce Hansen PhD
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  5. Rachel Vander Martin MS
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  6. Barbara Gerbert PhD
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  7. Thomas J. Coates PhD
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Additional information

Supported by Grant # CA38337 from the National Cancer Institute and by the Henry J. Kaiser Foundation Faculty Fellowship in General Internal Medicine (SRC).

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Cummings, S.R., Richard, R.J., Duncan, C.L. et al. Training physicians about smoking cessation. J Gen Intern Med 4, 482–489 (1989). https://doi.org/10.1007/BF02599545

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