Efficacy of Resident Training in Smoking Cessation

A Randomized, Controlled Trial of a Program Based on Application of Behavioral Theory and Practice with Standardized Patients

19 March 2002 | Volume 136 Issue 6 | Pages 429-437

Background: New educational programs must be developed to improve physicians' skills and effectiveness in counseling patients about smoking cessation.

Objective: To assess the efficacy of an educational program based on behavioral theory, active learning methods, and practice with standardized patients in helping patients abstain from smoking and changing physicians' counseling practices.

Design: Cluster randomized, controlled trial.

Setting: Two general internal medicine clinics in Switzerland.

Participants: 35 residents and 251 consecutive smoking patients.

Intervention: A training program administered over two half-days, during which physicians learned to provide counseling that matched smokers' motivation to quit and practiced these skills with standardized patients acting as smokers at different stages of change. The control intervention was a didactic session on management of dyslipidemia.

Measurements: Self-reported abstinence from smoking at 1 year of follow-up, which was validated by exhaled carbon monoxide testing at one clinic; score of overall quality of counseling based on use of 14 counseling strategies; patient willingness to quit; and daily cigarette consumption.

Results: At 1 year of follow-up, abstinence from smoking was significantly higher in the intervention group than in the control group (13% vs. 5%; P = 0.005); this corresponded to a cluster-adjusted odds ratio of 2.8 (95% CI, 1.4 to 5.5). Residents who received the study training provided better counseling than did those who received the control training (mean score, 4.0 vs. 2.7; P = 0.002). Smokers' willingness to quit was also higher in the intervention group (94% vs. 80%; P = 0.007). A nonsignificant trend toward lower daily cigarette consumption in the intervention group was observed.

Conclusion: A training program in smoking cessation administered to physicians that was based on behavioral theory and practice with standardized patients significantly increased the quality of physicians' counseling, smokers' motivation to quit, and rates of abstinence from smoking at 1 year.

Editors' Notes Context Training programs for counseling about smoking cessation have seldom shown a significant effect on sustained tobacco abstinence, possibly because most programs have used didactic teaching techniques. The effect of active learning methods on cessation rates is unknown. Contribution In this study, half the participating physicians were trained in the stages-of-change model and pharmacotherapy techniques. Counseling skills were practiced on standardized patients. The other half received no relevant training. One year later, patients of the trained residents showed a significantly higher smoking cessation rate than those of the untrained residents. Implications Training programs using active learning techniques increase the effectiveness of smoking cessation counseling. –The Editors

 

Author and Article Information

From Lausanne University Outpatient Clinic and Institute of Social and Preventive Medicine; Lausanne University and Lausanne University Hospital, Lausanne, and Geneva University Hospital, Geneva, Switzerland.

Presented at the plenary session of the 2000 Annual Meeting of the Society of General Internal Medicine, Boston, Massachusetts, May 2000.

Acknowledgments: The authors thank Professors Roger Darioli and Vincent Mooser from Lausanne University Hospital, who planned and tutored the control intervention, and Dominique Calloni, Annick Burckhard, Lea Makoundou, and Patrick Reutimann for help in collecting data.

Grant Support: By the Swiss Federal Office for Public Health, Swiss Medical Association, and Swiss Foundation for Health Promotion.

Requests for Single Reprints: Jacques Cornuz, MD, MPH, Centre Hospitalier Universitaire Vaudois, BH 10, CH-1011 Lausanne, Switzerland; e-mail, Jacques.Cornuz{at}chuv.hospvd.ch.

Current Author Addresses: Dr. Cornuz, Dr. Seematter, and Ms. Stoianov: Centre Hospitalier Universitaire Vaudois, BH 10, Bugnon 46, CH-1011 Lausanne, Switzerland.

Drs. Humair and Stalder: Policlinique de Médecine, Département de Médecine Communautaire, Hôpitaux Universitaires de Genève, Rue Micheli-du-Crest 24, CH-1211 Geneva, Switzerland.

Dr. van Melle: Institut universitaire de médecine sociale et préventive, Bugnon 17, CH-1011 Lausanne, Switzerland.

Dr. Pécoud: Policlinique Médicale Universitaire, Avenue César-Roux 19, CH-1005 Lausanne, Switzerland.

Author Contributions: Conception and design: J. Cornuz, J.-P. Humair, G. van Melle, H. Stalder, A. Pécoud.

Analysis and interpretation of the data: J. Cornuz, J.-P. Humair, L. Seematter, G. van Melle, A. Pécoud.

Drafting of the article: J. Cornuz, J.-P. Humair, L. Seematter, G. van Melle, H. Stalder, A. Pécoud.

Critical revision of the article for important intellectual content: J. Cornuz, J.-P. Humair, G. van Melle, H. Stalder, A. Pécoud.

Final approval of the article: J. Cornuz, J.-P. Humair, L. Seematter, R. Stoianov, G. van Melle, H. Stalder, A. Pécoud.

Provision of study materials or patients: J. Cornuz, J.-P. Humair, R. Stoianov, A. Pécoud.

Statistical expertise: J. Cornuz, G. van Melle.

Obtaining of funding: J. Cornuz, J.-P. Humair, H. Stalder, A. Pécoud.

Administrative, technical, or logistic support: J. Cornuz, J.-P. Humair, L. Seematter, R. Stoianov.

Collection and assembly of data: J. Cornuz, J.-P. Humair, L. Seematter, R. Stoianov.