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Implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions

BACKGROUND: The US Public Health Service smoking cessation practice guideline specifically recommends that physicians and nurses strongly advise their patients who use tobacco to quit, but the best approach for attaining this goal in the emergency department (ED) remains unknown. The aim of this stu...

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Autores principales: Katz, David A, Paez, Monica W, Reisinger, Heather S, Gillette, Meghan T, Weg, Mark W Vander, Titler, Marita G, Nugent, Andrew S, Baker, Laurence J, Holman, John E, Ono, Sarah S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3902188/
https://www.ncbi.nlm.nih.gov/pubmed/24460974
http://dx.doi.org/10.1186/1940-0640-9-1
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author Katz, David A
Paez, Monica W
Reisinger, Heather S
Gillette, Meghan T
Weg, Mark W Vander
Titler, Marita G
Nugent, Andrew S
Baker, Laurence J
Holman, John E
Ono, Sarah S
author_facet Katz, David A
Paez, Monica W
Reisinger, Heather S
Gillette, Meghan T
Weg, Mark W Vander
Titler, Marita G
Nugent, Andrew S
Baker, Laurence J
Holman, John E
Ono, Sarah S
author_sort Katz, David A
collection PubMed
description BACKGROUND: The US Public Health Service smoking cessation practice guideline specifically recommends that physicians and nurses strongly advise their patients who use tobacco to quit, but the best approach for attaining this goal in the emergency department (ED) remains unknown. The aim of this study was to characterize emergency physicians’ (EPs) and nurses’ (ENs) perceptions of cessation counseling and to identify barriers and facilitators to implementation of the 5 A’s framework (Ask-Advise-Assess-Assist-Arrange) in the ED. METHODS: We conducted semi-structured, face-to-face interviews of 11 EPs and 19 ENs following a pre-post implementation trial of smoking cessation guidelines in two study EDs. We used purposeful sampling to target EPs and ENs with different attitudes toward cessation counseling, based on their responses to a written survey (Decisional Balance Questionnaire). Conventional content analysis was used to inductively characterize the issues raised by study participants and to construct a coding structure, which was then applied to study transcripts. RESULTS: The main findings of this study converged upon three overarching domains: 1) reactions to the intervention; 2) perceptions of patients’ receptivity to cessation counseling; and 3) perspectives on ED cessation counseling and preventive care. ED staff expressed ambivalence toward the implementation of smoking cessation guidelines. Both ENs and EPs agreed that the delivery of smoking cessation counseling is important, but that it is not always practical in the ED on account of time constraints, the competing demands of acute care, and resistance from patients. Participants also called attention to the need for improved role clarity and teamwork when implementing the 5 A’s in the ED. CONCLUSIONS: There are numerous challenges to the implementation of smoking cessation guidelines in the ED. ENs are generally willing to take the lead in offering brief cessation counseling, but their efforts need to be reinforced by EPs. ED systems need to address workflow, teamwork, and practice policies that facilitate prescription of smoking cessation medication, referral for cessation counseling, and follow-up in primary care. The results of this qualitative evaluation can be used to guide the design of future ED intervention studies. TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT00756704
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spelling pubmed-39021882014-01-28 Implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions Katz, David A Paez, Monica W Reisinger, Heather S Gillette, Meghan T Weg, Mark W Vander Titler, Marita G Nugent, Andrew S Baker, Laurence J Holman, John E Ono, Sarah S Addict Sci Clin Pract Research BACKGROUND: The US Public Health Service smoking cessation practice guideline specifically recommends that physicians and nurses strongly advise their patients who use tobacco to quit, but the best approach for attaining this goal in the emergency department (ED) remains unknown. The aim of this study was to characterize emergency physicians’ (EPs) and nurses’ (ENs) perceptions of cessation counseling and to identify barriers and facilitators to implementation of the 5 A’s framework (Ask-Advise-Assess-Assist-Arrange) in the ED. METHODS: We conducted semi-structured, face-to-face interviews of 11 EPs and 19 ENs following a pre-post implementation trial of smoking cessation guidelines in two study EDs. We used purposeful sampling to target EPs and ENs with different attitudes toward cessation counseling, based on their responses to a written survey (Decisional Balance Questionnaire). Conventional content analysis was used to inductively characterize the issues raised by study participants and to construct a coding structure, which was then applied to study transcripts. RESULTS: The main findings of this study converged upon three overarching domains: 1) reactions to the intervention; 2) perceptions of patients’ receptivity to cessation counseling; and 3) perspectives on ED cessation counseling and preventive care. ED staff expressed ambivalence toward the implementation of smoking cessation guidelines. Both ENs and EPs agreed that the delivery of smoking cessation counseling is important, but that it is not always practical in the ED on account of time constraints, the competing demands of acute care, and resistance from patients. Participants also called attention to the need for improved role clarity and teamwork when implementing the 5 A’s in the ED. CONCLUSIONS: There are numerous challenges to the implementation of smoking cessation guidelines in the ED. ENs are generally willing to take the lead in offering brief cessation counseling, but their efforts need to be reinforced by EPs. ED systems need to address workflow, teamwork, and practice policies that facilitate prescription of smoking cessation medication, referral for cessation counseling, and follow-up in primary care. The results of this qualitative evaluation can be used to guide the design of future ED intervention studies. TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT00756704 BioMed Central 2014 2014-01-24 /pmc/articles/PMC3902188/ /pubmed/24460974 http://dx.doi.org/10.1186/1940-0640-9-1 Text en Copyright © 2014 Katz et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Katz, David A
Paez, Monica W
Reisinger, Heather S
Gillette, Meghan T
Weg, Mark W Vander
Titler, Marita G
Nugent, Andrew S
Baker, Laurence J
Holman, John E
Ono, Sarah S
Implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions
title Implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions
title_full Implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions
title_fullStr Implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions
title_full_unstemmed Implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions
title_short Implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions
title_sort implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3902188/
https://www.ncbi.nlm.nih.gov/pubmed/24460974
http://dx.doi.org/10.1186/1940-0640-9-1
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