Knowledge gaps about smoking cessation in hospitalized patients and their doctors

Abstract

Background: Hospitalization is an opportune time for smoking cessation support; cessation interventions delivered by hospital physicians are effective. While general practitioners' and outpatients' knowledge and attitudes towards smoking cessation have been studied in great detail, in-patient cessation programmes have received less attention. Design: Questionnaire-based survey of a convenience sample of hospital physicians and in-patients at Gottingen University Hospital, Germany. Methods: All 159 physicians directly involved in bedside care on medical and surgical wards received a three-page questionnaire examining smoking status, knowledge of smoking-attributable morbidity and mortality, and their understanding of the effectiveness of methods to achieve long-term smoking cessation. Perceived barriers to the delivery of counselling and cessation services to smoking patients were identified. One thousand randomly selected patients on medical (N = 400) and surgical (N = 600) wards were invited to complete a similar questionnaire. Results: Seventy-seven physicians (response rate 48.4%) and 675 patients (67.5%) completed the questionnaire. Patients and physicians alike underestimated the smoking-attributable risk of developing smoking-related cancers and chronic obstructive lung disease. In addition, severe misperceptions regarding the effectiveness of cessation methods were noted in both populations with 'willpower' being thought to be most effective in achieving abstinence. Only one-third of smoking patients recalled having been counselled to quit. Physicians identified lack of time as a central barrier to counselling smoking patients. Conclusions: These findings suggest that hospitalized smokers in a large German university hospital might not be treated according to international guidelines.