Anjali Singh, Daniel J Berger, Sarahrose Jonik, Meghan E Robbins, Steven King, Jessica Yingst
Background The effects of tobacco use create a significant burden on the American healthcare system. The U.S. Preventive Services Task Force (USPSTF) recommends a tobacco cessation framework consisting of asking all patients about any tobacco use, advising they quit, assessing their willingness to start a quit attempt, assisting in any attempts, and arranging follow-up. This is known as the "5A's" and is considered a standard of care for tobacco cessation. Physician-provided cessation interventions have been shown to be effective in helping patients stop their tobacco use; however, studies have shown that physicians and other healthcare providers do not consistently offer tobacco cessation interventions. This study aimed to evaluate healthcare providers' comfort with and self-reported use of tobacco cessation interventions. Methods An online survey was made available to all Penn State Health Milton S. Hershey Medical Center physicians, physician assistants (PAs), nurse practitioners (NPs), registered nurses (RNs), and respiratory therapists (RTs). The survey assessed respondents' use of the USPSTF "5A's" cessation framework, comfort in counseling patients, use of cessation interventions, and desire for further education. Descriptive statistics were generated, and chi-square tests were used to compare differences in responses across provider groups. Results A total of 430 healthcare professionals (mean age of 40.1 years, 76.1% female) responded to the survey, including 55 (12.1%) physicians, 76 (17.7%) resident/fellows, 44 (10.2%) PAs, 57 (13.5%) NPs, 146 (33.9%) RNs, and 54 (12.5%) RTs. The majority (n = 407, 95.5%) of respondents reported a belief that it is "extremely" or "very" important for their patients to stop smoking cigarettes. Although more than 160 (70%) providers reported feeling "very comfortable" or "somewhat comfortable" counseling patients who were "ready to quit" smoking, only half reported the same for patients who were "not ready to quit." There was significant variation in the use of the recommended "5A's," with NPs and attending physicians reporting the most regular use. Self-reported use of the "Ask" and "Advise" components of the "5A's" was higher than the "Assess", "Assist", and "Arrange" components, with low rates of use of pharmacologic cessation methods. Only 13 (3.2%) providers reported regularly billing for cessation counseling. Conclusions While healthcare professionals recognize the importance of tobacco cessation for their patients, gaps persist in the consistent application of the "5A's" model and provider comfort in counseling patients to quit, particularly those perceived as "not ready to quit." This discomfort with counseling, along with hesitancy to offer cessation interventions, results in missed opportunities to help patients with tobacco use disorder. Differences in cessation practices across healthcare roles suggest opportunities for targeted improvement. Enhancing both provider training and health system interventions is essential for expanding patient access to effective cessation interventions.
