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Can residents be trained to counsel patients about quitting smoking?

Results from a randomized trial

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Abstract

Study objective:To evaluate the effectiveness of two teaching interventions to increase residents’ performance of smoking cessation counseling.

Design:Randomized controlled factorial trial.

Setting:Eleven residency programs, in internal medicine (six), family medicine (three), and pediatrics (two). Programs were located in three university medical centers and four university-affiliated community hospitals.

Participants:261 residents who saw ambulatory care patients at least one half-day per week, and 937 returning patients aged 17 to 75 years who reported having smoked five or more cigarettes in the preceding seven days. Of the 937, 843 were eligible for follow-up, and 659 (78%) were interviewed by phone at six months.

Interventions:Two interventions (tutorial and prompt) and four groups. The tutorial was a two-hour educational program in minimal-contact smoking cessation counseling for residents. The prompt was a chart-based reminder to assist physician counseling. One group of residents received the tutorial; one, the prompt; and one, both. A fourth group received no intervention.

Measurement and results:Six months after the intervention, physician self-reports showed that residents in the tutorial + prompt and tutorial-only groups had used more counseling techniques (1.5–1.9) than had prompt-only or control residents (0.9). Residents in all three intervention groups advised more patients to quit smoking (76–79%) than did control group residents (69%). The tutorial had more effect on counseling practices than did the prompt. Physician confidence, perceived preparedness, and perceived success followed similar patterns. Exit interviews with 937 patients corroborated physician self-reports of counseling practices. Six months later, self-reported and biochemically verified patient quitting rates for residents in the three intervention groups (self-reported: 5.3–8.2%; biochemically verified: 3.4–5.7%) were higher than those for residents in the control group (self-reported: 5.2%; biochemically verified: 1.7%), though the differences were not statistically significant.

Conclusion:A simple and feasible educational intervention can increase residents’ smoking cessation counseling.

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Authors and Affiliations

  1. the Faculty Development Program in General Medicine and General Pediatrics, the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Jorge J. Gonzalez MD, C. Stewart Rogers MD & Clare J. Sanchez MD

  2. the Faculty Development Program in General Medicine and General Pediatrics, the Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Richard D. Kenney MD

  3. the Office of Educational Development, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Frank T. Stritter PhD

  4. the Area Health Education Centers Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Elizabeth E. Campbell MD, Jorge J. Gonzalez MD, Richard D. Kenney MD, C. Stewart Rogers MD & Clare J. Sanchez MD

  5. School of Medicine, the Department of Health Behavior and Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Victor J. Strecher PhD

  6. School of Public Health, the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Michael S. O’Malley MSPH & Elizabeth E. Campbell MD

  7. the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Victor J. Strecher PhD

  8. the Department of Medicine, Bowman Gray School of Medicine, Winston-Salem, North Carolina

    Mary F. Lyles MD

  9. the Department of Medicine and Pediatrics, East Carolina University School of Medicine, Greenville, North Carolina

    Thomas G. Irons MD & Robert C. Turner MD

  10. Louisiana State University School of Medicine and Medical Center, New Orleans, Louisiana

    Susanne T. White MD

  11. the Geisinger Medical Center, Danville, Pennsylvania

    Victor G. Villagra MD

  12. the Annals of Internal Medicine, Philadelphia, Pennsylvania

    Suzanne W. Fletcher MD

Authors
  1. Victor J. Strecher PhD
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  2. Michael S. O’Malley MSPH
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  3. Victor G. Villagra MD
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  4. Elizabeth E. Campbell MD
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  5. Jorge J. Gonzalez MD
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  6. Thomas G. Irons MD
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  7. Richard D. Kenney MD
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  8. Robert C. Turner MD
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  9. C. Stewart Rogers MD
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  10. Mary F. Lyles MD
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  11. Susanne T. White MD
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  12. Clare J. Sanchez MD
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  14. Suzanne W. Fletcher MD
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Additional information

Supported by the University of North Carolina Faculty Development Program in General Medicine and General Pediatrics (PE54004, Bureau of Health Professions, Washington, D.C.) and by grants from the Cancer Prevention and Control Program of the National Cancer Institute (RO3-CA43994), the North Carolina Chapter of the American Heart Association (1986-86-37-A), and the University of North Carolina Center for Health Promotion and Disease Prevention.

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Strecher, V.J., O’Malley, M.S., Villagra, V.G. et al. Can residents be trained to counsel patients about quitting smoking?. J Gen Intern Med 6, 9–17 (1991). https://doi.org/10.1007/BF02599383

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