Barriers to helping patients quit smoking: Lack of knowledge about cessation methods, E-cigarettes, and why nurse practitioners and physician assistants can help

• Type of Material: Article
• Authors: Johann Lee Westmaas, Emory University; Israel Kates, Booz Allen Hamilton; Laura Makaroff, American Cancer Society; Rosie Henson, Emory University
• Language: English
• Date: 2023-07-23
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2023 American Cancer Society
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.puhip.2023.100409
• Title of Journal or Parent Work: Public Health in Practice
• Volume: 6
• Grant/Funding Information: This research was funded by the American Cancer Society.
• Keywords: Nurse practitioners; Cessation; Health care professionals; Physician assistants; Oncology; Smoking; E-cigarettes
• Research Categories: Health Sciences, Oncology; Health Sciences, Public Health

Abstract

Objectives Health care settings are ideal for addressing patients' smoking and quitting, but barriers may limit providers’ assistance with cessation, including lack of knowledge about newer devices being used by some smokers to quit (e.g., e-cigarettes). Cessation practices among nurse practitioners (NPs) and physician assistants (PAs) are also unknown. Study design Cross-sectional. Methods Participants (N = 459) were 151 oncologists, 150 primary care physicians (PCPs), 98 nurse practitioners (NPs), and 60 physician assistants (PAs) recruited from a national online panel who completed an online survey. Results Four barriers were common across specialties: “patient doesn't want to quit, and it is their decision,” “smoking is not reason for patient's visit; must treat the immediate problem first,” “patient wants to quit on their own,” and “lack of effective methods available.” While a majority of oncologists (58%) were aware of free telephone counseling for cessation, only 29% of NPs were aware. Perceived knowledge of e-cigarettes was low. Greater comfort treating patients' smoking predicted greater frequency of engagement in 4 of 5 general cessation practices (βs = 0.15-0.26, all p ≤ .001). NPs and PAs more frequently asked patients about smoking and e-cigarette use compared to oncologists, but oncologists more frequently referred patients to effective quitting resources (e.g., quitlines). Conclusions NPs and PAs may be uniquely positioned to provide cessation assistance, but providers need more education on currently available, effective cessation methods, and about e-cigarettes. Addressing patient resistance to offers of cessation services and improving clinical workflows to enhance cessation service provision should be investigated in future research.