Smoking
Conditions
Keywords
Smoking Cessation, Tobacco Use Cessation, Motivational Interviewing, Students, Medical, Randomized Controlled Trial
Brief summary
Background: Smoking counselling during hospitalisation with post-discharge follow-up increases quitting. However, provision of cessation care for hospitalised patients is suboptimal. Students are potentially an untapped resource for providing cessation advice, but no studies have investigated this. Aim: To determine if medical students can encourage motivation to stop smoking (MTSS; primary outcome) in hospitalised smokers . Design: 2-arm RCT Setting: RCSI (www.rcsi.ie) and Connolly Hospital (www.hse.ie/eng/services/list/3/hospitals/Connolly/). Participants: Inpatient smokers. Intervention and procedures: 60 graduate medical students will receive standardised motivational interviewing training in the provision of cessation advice. Each student will be randomly assigned to counsel \ 1-3 smokers each, including an individual in-hospital, face-to-face session and post-discharge phone counselling. Training and implementation will cover Sept-2015-May-2016. Smokers will be randomised to 'usual care' (n\ 90), or intervention (n\ 90, student-delivered motivational interviewing). A researcher will enable recruitment and follow-up, and conduct a qualitative evaluation of programme participants.
Interventions
BEHAVIORALMotivational interviewing
The medical student will deliver a brief (approximately 15 minute) consultation with the patient that is based on principles of social cognitive theory and motivational interviewing. The goals of this consultation will be to enhance the patient's motivation and self-efficacy regarding quitting, and collaboratively elicit a plan to stay quit after discharge. Patients will be offered the opportunity to receive a consultation from the attending physician to determine eligibility for pharmacotherapy (via a chart sticker). Each student will counsel 1-3 smokers each over the 8-month academic period, with student training and intervention staggered over this time. Students will also re-contact the smoker at 1-week post-discharge via telephone or personal follow-up, to provide further support.
Sponsors
Health Service Executive, Ireland
University of Memphis
Connolly Hospital Blanchardstown
Royal College of Surgeons, Ireland
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* All identified inpatient smokers at Connolly Hospital.
Exclusion criteria
* Advised by ward manager that patient is too unwell or cognitively impaired, or otherwise unsuitable; * Death during hospitalisation; * Receiving palliative care; * Under 18 years of age; * To be transferred to another hospital; * Not English speaking; * Refusal to participate; * Inpatient in psychiatric ward
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Motivation to Stop Smoking Scale (MTSS) | Repeated measures: MTSS scores at baseline, 1-week, 3- and 6-month follow-up. | Repeated measures: MTSS scores at baseline, 1-week, 3- and 6-month follow-up. |
| Change in motivation to quit | Repeated measures: single item scores at baseline, 1-week, 3- and 6-month follow-up. | If, on a scale of 1 to 10, 1 is not at all motivated to give up smoking and 10 is 100% motivated to give up, what number would you give yourself at the moment? |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| proportion of patients who report any use of a prescribed or over-the-counter cessation medication | at 3- and 6-months discharge | the proportion of patients who report any use of a prescribed or over-the-counter cessation medication, of an approved cessation pharmacotherapy, including nicotine patch, gum, lozenge, inhaler, mouth spray, Champix, or Zyban at 1- and 6-months discharge |
| Proportion of patients who receive a prescription for a cessation medication at the time of discharge | By discharge, an average of 5-10 days post-admission | The proportion of patients who receive a prescription for a cessation medication at the time of discharge, assessed via medical chart audit; |
| proportion of attending physicians who prescribe cessation medication during the hospitalisation | During hospitalisation (baseline) | the proportion of attending physicians who prescribe cessation medication during the hospitalisation (to be obtained by medical chart audit); |
| 7-day point prevalent abstinence rates | 3- and 6-months | 7-day point prevalent abstinence rates assessed at both 3- and 6-months by self-report |
Other
| Measure | Time frame | Description |
|---|---|---|
| Perceived student knowledge | 3- and 6-months | Single item survey: How knowledgeable was the medical student about quitting smoking? \[not at all, a little bit, somewhat, quite a bit, or very much\] |
| Quit attempts | 3- and 6-months | Three questionnaire items: 1. In the past one/six months, have you quit smoking? Yes/No 2. If no, in the past one/six months have you attempted to quit smoking? Yes/No 3. If yes, how many times have you tried to quit in the past three/six months? \_\_\_\_\_\_ |
| Perceived student efficacy | 3- and 6-months | Single items survey: How helpful was the support that you received from the medical student? \[not at all, a little bit, somewhat, quite a bit, or very much\]? |
| Professional advice | 3- and 6 months | One questionnaire item: In the past 3/6 months since your hospital admission, did a doctor or health professional discuss ways of giving up smoking with you? |
Countries
Ireland
Outcome results
None listed