|
 
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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 13
| Issue : 1 | Page : 18-25 |
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Knowledge of health-care professionals on tobacco cessation and its related activities
Neetu Kataria1, Sandhya Gupta2
1 PG Student, College of Nursing, AIIMS, New Delhi, India
2 Health Consultant and Lifestyle Coach, Formerly Principal (Acting) and Associate Professor, Department of Nursing, AIIMS, New Delhi, India
| Date of Submission | 11-Oct-2022 |
| Date of Decision | 01-Jan-2023 |
| Date of Acceptance | 08-Feb-2023 |
| Date of Web Publication | 24-Feb-2023 |
Correspondence Address:
Dr. Sandhya Gupta
College of Nursing, All India Institute of Medical Science, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/cmrp.cmrp_99_22
Background: The tobacco epidemic is one of the biggest public health threats the world has ever faced. There are more than 4000 chemicals in tobacco smoke, of which at least 300 are known to be harmful. A 2015 survey in Italy revealed that 58% of cardiologists correctly indicated smoking as an addiction and 45% regularly advised their patients to stop smoking.
Aims: The aim is to assess the knowledge of health care professionals (HCPs) related to tobacco cessation and its related activities.
Materials and Methods: A descriptive, cross-sectional, pilot survey on HCPs-30 doctors and 30 nurses was chosen by convenient sampling at a selected tertiary care hospital in New Delhi. Tool: A semi-structured questionnaire contains items to assess knowledge of HCPs regarding tobacco cessation and its activities.
Results: 96.3% of doctors and 76% of nurses were 'asked' their patients about their history of tobacco use, respectively. 86.7% of doctors and 70.1% of nurses 'advice' patients to stop tobacco use. 63.3% of doctors and 54.1% of nurses were interested in participating in tobacco cessation training.
Conclusion: Most of the HCPs had given brief interventions by 5 'A's method. More tobacco cessation training would be suggested by health-care workers.
Keywords: Health care professionals, tobacco cessation activities, tobacco
How to cite this article:
Kataria N, Gupta S. Knowledge of health-care professionals on tobacco cessation and its related activities. Curr Med Res Pract 2023;13:18-25 |
| Introduction | |  |
According to the WHO, 2018[1] 'The tobacco become one of the biggest epidemic to threat the health of the common public. Around 8 million people were killed due to tobacco all around the world. Only 1 in 3 countries, representing 39% of the world's population, monitors tobacco use by repeating nationally representative youth and adult surveys at least once every 5 years. Causes of cancer are 50 known substances whereas 250 chemicals cause harms out of total of 4000 chemicals in tobacco smoke.'
In a 2010 survey in China, Yang et al., 2010[2] revealed that smokers of only 38% knew that smoking causes coronary heart disease whereas 27% knew that it causes a stroke.
A 7% decrease in tobacco consumption due to the banning of all types of advertising, promotion and sponsorship while some of the countries experienced a decline in consumption of up to 16%, WHO (2018).[1] The WHO Framework Convention on Tobacco Control (WHO FCTC), MPOWER, WHO 2019[3] entered into force in February 2005 and has today 181 Parties covering more than 90% of the world's population. In 2007, WHO introduced a practical, cost-effective way to scale up the implementation of the main demand reduction provisions of the WHO FCTC on the ground: MPOWER.[3]
A 2015 survey in Italy, by Cesana et al., in 2015[4] revealed that 58% of cardiologists correctly indicated smoking as an addiction and 45% regularly advised their patients to stop smoking. Most of the cardiologists reported a positive attitude toward smoking cessation strategies, 62% of them thought that cardiologists themselves should treat smoking dependence, 70% of them were using specific tools and 66% of them were using education for the management of smoking cessation. Doctors and nurses failed to ask tobacco related history from their patients and tobacco is found to be the main cause of cardiac and nervous system-related disorders. This study will give baseline data to administration and faculties to trigger training activities for doctors and nurses regarding tobacco cessation and its activities to prevent the burden due to morbidity and mortality due to relapse of tobacco use and re-occurrence of disease. The objective of the study is to assess knowledge of health-care professionals (HCPs) related to tobacco cessation and its related activities.
| Materials and Methods | | |
A descriptive, cross-sectional pilot survey was conducted upon HCPs-30 doctors and 30 nurses (HCPs-30 D-N) chosen by convenience sampling at a selected tertiary care hospitals in New Delhi, India.
Operational definition-health-care professionals doctors
Doctors who were working at Neuro and Cardio Units and given willingness to participate in the study were included after taking consent from them in the study. HCP-N were working at Neuro and Cardio Units and given the willingness to participate in the study were included after taking consent from them in the study. The brief intervention 5 'A'-Ask, Advice, Assess, Arrange, Assist. It was developed by the US preventive services task force for adductors. The brief intervention of 5 'A' includes questions to ask all the patients whether they smoke; advise the smokers to quit; assess willingness to quit; assist with quitting treatment/referrals and arrange follow-up contact used in this study for both groups of participants.
HCPs working in units/departments in cardio and neuro centres units of AIIMS hospital, New Delhi, India, were excluded from the study. The study duration was 1 month, July 2017.
A semi-structured questionnaire
It was developed by a researcher and contains 5 items in it. It includes open as well as closed-ended type of questions to assess knowledge of HCPs regarding knowledge on tobacco cessation and its related activities.
Ethical consideration
Ethical permission was obtained from Institutional Ethical Committee, tertiary care hospital, Delhi. Subjects were ensured for maintaining confidentiality and privacy during and after data collection. A written informed consent was obtained after explaining the study title, objectives, duration and its benefit/harm. All guidelines from ICMR, IEC, good clinical practice and the Declaration of Henske were adopted in the study.
Method of data collection
Permission was obtained from the concerned authority before data collection. The subjects who fulfilled the inclusion criteria at neuro-centre were enrolled after getting informed consent for the study. Data were collected using semi-structured questionnaires which were filled out by the participants. The researcher was thankful to each participant to filling tool and showing cooperation. It took approximately 5 min to collect the data. Data was collected in MS excel 13 version sheet and analysed using descriptive statistics as frequency % in tabulated forum.
| Results | | |
[Table 1] shows that HCP-D reported, most (96.7%) of them reported that they 'ask' patients specifically about tobacco use. Most (86.7%) of the patients were 'advised' to stop tobacco use, 13.3% of them advised that it is injurious to health, 33.3% of doctors 'arrange' for de-addiction centre, 6.7% 'assist' in brief intervention, 6.7% assist in providing nicotine chewing gum, 3.3% assisting in providing pharmacotherapy, 3.3% assisted in providing health education regarding replacement with fresh fruits–vegetables, meditation or yoga, mind-diversional activities, refer to ENT if any oral ulcer or growth seen. There are some 'reasons' came out such as lack of knowledge, lack of time to send them to de-addiction centre, de addiction centre is far-away, if severity of tobacco abuse then only send to de addiction, not-applicable as posted in neuro-radiology and surgical department, boring process/negative attitude towards sending them into de-addiction centre, referral to pulmonary medicine. There were some novice 'solutions' came out like providing incentives (6.7%), keep them busy in work (3.3%), keep away all triggering factors-pan shop, tobacco user's peer group (3.3%), visit to oncology unit to show buccal cavity cancer patients (3.3%), provide chewing gum (13.3%), photos of normal person and tobacco user's (3.3%), providing education to school adolescent for prevention of tobacco abuse (3.3%), motivation by closed one like a girlfriend, spouse or any family member (3.3%), self-help groups (3.3%), send to de-addiction centre (20%), behavioural therapy, psychotherapy (6.7%) and religious guidance (3.3%). Whereas 36.7% of doctors would not like to participate in any formal training related to tobacco cessation and its activities.
[Table 2] shows that most (73.3%) of the HCP nurses reported that they 'ask' patients specifically about tobacco use. 33.3% of them 'advised' that tobacco is injurious to health-cancer, Passive smoking-harm to loved ones (13.5%), 'Arrange' for De-addiction centre (13.5%), 'Assist' in brief intervention (2.7%), provide Nicotine gum (2.7%), reduce the number of cigarettes packets day by day (2.7%), take other substance fruits, refreshment instead of tobacco (6.7%), involvement of family members and relatives (6.7%), meditation or yoga (2.7%), mind-diversional activities (2.7%). There were some 'reasons' came out such as lack of knowledge, lack of time to send them to de-addiction centre, de-addiction centre is far-away, nurses felt they do not have authority, lack of confidence if the severity of tobacco abuse found then only send to de-addiction. There were some 'solutions' that came out like motivation about the benefits of stopping the use of tobacco (24.3%), visit to oncology unit to show buccal cavity cancer patients (13.5%), side effects of tobacco use teach by closed one like girlfriend, spouse or any family member (18.9%), providing chewing gum (8.1%), incentives (6.7%), keep them busy in work (8.1%), suggested that passive smoking harms to their loved ones (8.1%), provide natural herbs-keep Jeera/fennel seeds or any sweets to keep in the mouth to chew (8.1%), photos of a normal person and tobacco user's (6.7%), keep away all triggering factors-pan shop, tobacco user's peer group (2.7%), providing health education to school adolescent for prevention of tobacco abuse (2.7%), music, holiday trips (Mind-Diversional therapy) (2.7%), self-periodic monitoring (2.7%), self-help groups (2.7%), send them to de-addiction centre (2.7%). There were 27% of nurses who would not like to participate in any formal training related to tobacco cessation and its activities.
| Discussion | | |
Health-care professional-Doctors
In this study's findings, HCP doctors reported 96.7% of them 'ask' their patients specifically for tobacco abuse in any form of Gutka, pan masala, pan, surti, bidi, cigarette, hukka, Naswar which is supported by the study of Finegan et al.[5] which suggested 545 had their smoking status documented. Moreover, a study of Steliga[6] suggested that 45% of physicians regularly advised their patients to stop smoking. Similarly, a study done by Odukoya et al.[7] suggested that 42.9% of documentation of physicians' showed inquiry of client's tobacco use. Consecutively, study done by Everatt et al.[8] revealed that 23% of family doctors always ask their patients about smoking habits. Similarly, a study done by Jradi (2017)[9] revealed that 53.2% of physicians reported asking and documenting the patient's smoking status. In consistency of above-written findings, another study of Li and Chao[10] suggested that most (97%) of dentists reported that they would enquire into every patient's smoking status whereas only half of them asked routinely. Similarly, a study done by Abdullah et al.[11] reported that 77% of the doctors obtained information on their patients' smoking status.
In this present study, 96.7% of the doctors reported that they 'advise' to stop smoking to their patients which is supported by a study done by Finegan et al.[5] revealed that 50% were offered NAM before discharge. Similarly, a study done by Odukoya et al.[7] suggested that 12.9% of physicians were advised some form of tobacco cessation advice. Another study done by Everatt et al.[8] also revealed same as 59% of family doctors always advise smoking patients to quit smoking. Consecutively, a study on Italian cardiologists and tobacco smoking by Frisinghelli et al. (2015)[4] suggested that 45% of cardiologists regularly advised their patients to stop smoking. Similarly, a study done by Li and Chao[10] revealed that 95% of dentists claimed they actually advised Smoking cessation advice. Another study done by Cornuz et al. (2007)[12] suggested that for smokers who do not intend to quit smoking, physicians should inform and sensitise them about tobacco use and cessation. Investigation of the study done by Abdullah et al.[11] revealed that 29% of doctors advised all smoking patients to quit. Another study done by Johnson et al.[13] suggested that most (64%) of respondents-dentists stated that they gave advice on tobacco cessation 'fairly regularly' or 'always' (whether asked or not).
In this present study, 13.3% of doctors reported they had advised as it is injurious to health cancer which is supported by another study done by Warren et al.[14] suggested that poorer survival in lung cancer as well as decreased efficacy of radiation and chemotherapy with continued smoking, particularly detailing the role that nicotine and its metabolites play in the promotion of tumor growth through multiple pathways, including increased proliferation, angiogenesis, migration, invasion, epithelial to mesenchymal transition and stimulation of autocrine loops associated with tumor growth.
In our study, doctors reported that 33.3% of them arrange for de-addiction centre which is supported by a study done by Everatt et al.[8] which suggested that 22% of family doctors refer for a specialised smoking cessation treatment.
In our study, 6.7% of the doctor assist in brief intervention which is supported by another article on five major steps to intervention (The '5 A's')[15] suggested that key components of this message are often summarised as the 5 A's: ask, advise, assess, assist and arrange.
In our study, 23.3% of doctors assist in providing chewing gum these findings are supported by another study done by Everatt et al.[8] revealed that 15% of family doctors prescribed nicotine replacement therapy. Similarly, a study done by Cornuz et al.[12] suggested that for smokers ready to quit, the physician showed strong support, helps set a quit date, prescribes pharmaceutical therapies for nicotine dependence, such as nicotine replacement therapy (i.e. gum, transdermal patch, micro and sublingual tablets) supported our study findings. Consecutively, another study done by Kotz et al.[16] suggested that Pharmacological aids for smoking cessation such as nicotine patches and nicotine gum were prescribed by lung physicians (6.3%, 18.2%), then general practitioners (GPs) (18.7%, 9.8%, respectively) and cardiologists (19.7%, 13.2%, respectively) supported present study findings. Another study done by Johnson et al.[13] suggested that 37% of respondent-dentists recommended over-the-counter nicotine replacement therapy which supports this study's finding.
In this study, 3.3% of doctors assist in prescribing pharmacotherapy which is supported by a study of Everatt et al.[8] suggested that 6% of family doctors prescribed Varenicline or Bupropion. Similarly, another study done by Kotz et al.[16] revealed that for smokers ready to quit, the physician showed strong support, helped set a quit date, prescribe pharmaceutical therapies for nicotine dependence, such as bupropion (atypical antidepressant thought to work by blocking neural re-uptake of dopamine and/or norepinephrine), with instructions for use, and suggest behavioural strategies to prevent relapse which supports this present study. Consecutively, an article on five major steps to intervention (The '5 A's')[15] suggested that pharmacological aids for smoking cessation such as bupropion were prescribed by lung physicians (67.0%) than GPs (65.7% and cardiologists (31.6%) respectively which support present study findings.
In this present study, doctors reported that due to a lack of knowledge, they did not advise their patients to de-addiction centre which is supported by a study done by Harutyunyan et al.(2019)[17] revealed that 46.30% of physicians thought insufficient knowledge on smoking cessation interventions was an important barrier. Similarly, another study on Italian cardiologists and tobacco smoking. A survey by Frisinghelli et al.[4] suggested that 66% of cardiologists thought that education for the management of smoking cessation was lacking which supports the present study findings. Consecutively, another study by Warren, Marshall et al.[18] suggested that health-care providers had a lack of knowledge, experience, or skill in identifying and addressing substance misuse which supports the present study findings. Similarly, a study done by Jradi H and et al. (2015)[9] suggested that for those physicians who do understand the importance, there may be a lack of familiarity with cessation strategies, resources and medications which supports the present study findings. Another study done by Wells et al.[19] suggested that Current practices, attitudes and perceived barriers for treating smokers, similarly study done by Hong Kong dentists, Li and Chao (2014)[10] suggested that 25% of dentists regarded 'lack of training' as 'very important' barrier which supports the present study.
In this present study, doctors reported that lack of time to send them for de-addiction centre which was supported by a study done on the impact of knowledge by Clarke et al.[20] suggested that there was a real lack of time to deliver comprehensive effective cessation by the physician in a busy practice, and there may be the perception that there is not enough time to do effective cessation intervention and health care providers' lack of support structures such as sufficient time, staff and resources in working with this population which supports present study findings. Similarly, another study done by Jradi (2017)[9] revealed that 72.6% of physicians reported barrier was mostly lack of time which supports the present study findings. Consecutively, another study by Wareen GW et al.(2018)[18] suggested that 50% of physicians thought lack of time was somewhat a barrier which supports the present study findings.
In this present study, doctors suggested the reason as if the severity of abuse then only send to de addiction which was supported by a study done by Webb et al.[21] suggested that the physician may perceive a lack of importance that cessation impacts outcomes.
In this present study, doctors suggested that there was no role in sending for de-addiction as they were posted in radiology and surgical department which was supported by a study done on barriers and facilitators to smoking cessation in a cancer context: A qualitative study of patient, family and professional views Wells et al.[19] suggested that have a sense of futility in that the patient already has developed the smoking-related disease and it is too late to make any difference.
In this present study, doctors reported sending tobacco users felt boring process/negative attitude into de-addiction centre which was supported by another study done by Webb et al.[21] suggested that physicians may express a feeling of futility—patients would not quit regardless of advice or support. Health-care providers' found to had negative attitude towards this patient population.
In this present study, 13.3% of doctors reported that to help tobacco users by giving motivation verbally about positive of stop using tobacco which was supported by Cornuz et al.[12] suggested that for smokers who are dissonant, physicians used motivational strategies, such as discussing barriers to cessation and their solutions.
In this present study, 63.3% of doctors reported that they would like to undergo formal training on tobacco cessation activities which was supported by Italian cardiologists and tobacco smoking: A survey by Frisinghelli et al.[4] suggested that two-thirds of the entire sample of ANMCO cardiologists declared their willingness to participate in specialised educational programs.
Health care professional-Nurses
In this present study, 73% of HCP nurses 'ask' their patients specifically about the use of tobacco in any form of Gutka, pan masala, pan, surti, bidi, cigarette, hukka, Naswar which was supported by a study done by Sonmez et al.[22] revealed that 80% of primary care nurse's routine asking about patients' smoking habits. Similarly, another study done by Sarna et al.(2016)[23] suggested that 64% of Chinese registered nurses consistently asked about smoking status of patients which was found to be consistent to our study findings. Consecutively, study done by Mak et al.[24] revealed that over half of the nurses frequently (sometimes and often) asked (59.1%) patients regarding their smoking status. Another study done by Králíková et al.[25] stated that nurses usually/always (58%–69%) ask patients about smoking which found to be consistent with our study findings.
In this present study, 70% of nurses 'advice' their patients to stop smoking which was supported by a study done by Sonmez et al.[22] suggested that 80.7% of primary care nurses' routine advice patients to quit smoking. Consecutively, a study by Sarna et al.[26] stated that 85% of Chinese registered nurses were advised patients to quit which found to be consistent with our study findings. Another study done by Sarna et al.[26] revealed that 22% of Czech nurses reported that they could play an important role in helping patients quit which was found to be consistent with the present study findings. Similarly, a study done by Mak et al.[24] stated that 64.9% of nurses frequently 64.9% advised smokers to quit smoking. Another study done by Králíková et al.[25] revealed that 56%–66% of nurses recommend patients stop smoking.
In this present study, 13.5% of nurses 'advice' their patients to stop smoking which was supported by a study done by Sarna L et al.(2016)[23] stated that 17% of Chinese registered nurses arranged for follow-up. Similarly, a study done by Králíková et al.[25] revealed that 7%–10% of increase in nurses for arranging follow-up that constitute a statistically significant improvement among smokers which found to be consistent to our study findings.
In this present study, 2.7% of nurses reported that they 'b' their patients in brief intervention which was supported by Sarna et al.[26] stated that 26% of Czech nurses reported 'always' assisted patients with smoking cessation. Similarly, a study done by Sarna et al.(2016)[23] revealed that 38.9% of nurses had utilised various ways to assist smokers to quit smoking which found to be consistent with to present study findings. Consecutively, a study done by Králíková et al.[25] stated that 21%–33% of nurses were assisting smokers for cessation which supports present study findings. In this present study, 8.1% of nurses 'advice' that passive smoking harms to their loved ones which was supported by another study done by Sonmez et al.[22] stated that 97.5% of primary care nurse's advice patients to avoid smoking around the children.
In this present study, 54.1% of nurses were trained in tobacco cessation activities which were supported by a study done by Sonmez et al.[22] stated that 78.3% of primary care nurses getting a specific training on cessation.
| Conclusion | | |
Most of HCPs had given brief intervention by 5 'A's method such as ask, advice, arrange, assist for their patients regarding their history of tobacco use and its cessation activities. More formal training to enhance knowledge would be suggested by HCPs on tobacco cessation and its related activities.
Limitations
This was a self-reported survey and smaller sample size survey as a pilot survey.
Strengths of the study
This survey will be an eye opener for the administration for knowledge of HCPs regarding most widely tobacco use and its cessation activities. Both open as well as closed-ended questions were included in survey. Maximum possible answers were descriptively analysed.
Implications of the study
There need for the development of a liaison between Cardio, Neuro units and de-addiction unit which will be helpful for the patient for easy referral and seeks need-based services and counseling is one of them. All HCPs must be trained in providing brief intervention.
The outpatient clinics must mandate the screening of their patient for substance abuse and send them for early de-addiction. Its treatment to prevent relapse of substance abuse behaviour post-cerebral or cardiac lethal events.
Data availability statement
The data that support the findings of this study are available from the corresponding author, (N. K), upon reasonable request.
Acknowledgement
Authors would like to acknowledge all the participants for their cooperation.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]
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