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Training Physicians in Counseling about Smoking Cessation: A Randomized Trial of the "Quit for Life" Program

Steven R. Cummings, MD; Thomas J. Coates, MD; Robert J. Richard, MA; Bruce Hansen, PhD; Elaine G. Zahnd, PhD; Rachel VanderMartin, MS; Carol Duncan, MPH; Barbara Gerbert, PhD; Albert Martin, MD; and Morton J. Stein, MD
[+] Article, Author, and Disclosure Information

Grant Support: Partial support by grant CA38337 from the National Cancer Institute. Dr. Cummings' work was supported in part by the Henry J. Kaiser Foundation Faculty Fellowship in General Internal Medicine.

Requests for Reprints: Steven R. Cummings, MD, University of California Medical Center, 400 Parnassus, A-405, San Francisco, CA 94143-0320.

Current Author Addresses: Drs. Cummings, Coates, Zahnd, and Martin, Mr. Richard, Ms. VanderMartin, and Ms. Duncan: Division of General Internal Medicine, University of California, San Francisco, CA 94143.

Dr. Hansen: Department of Clinical Psychology, Kaiser-Permanente Medical Group, Honolulu, HI 96750.

Dr. Gerbert: Department of Dental Public Health and Hygiene, School of Dentistry, University of California, San Francisco, CA 94143.

Dr. Stein: Department of Medicine, Kaiser-Permanente Medical Group, San Francisco, CA 94115.

©1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(8):640-647. doi:10.7326/0003-4819-110-8-640
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Study Objective: To test whether physicians who receive a continuing education program ("Quit for Life") about how to counsel smokers to quit would counsel smokers more effectively and have higher rates of long-term smoking cessation among their patients who smoke.

Design: Randomized trial with blinded assessment of principal outcomes.

Setting: Four health maintenance organization medical centers in northern California.

Subjects: Eighty-one internists assigned by blinded randomization to receive training (40) or serve as controls (41). Consecutive samples of smokers visiting each physician (mean, 25.6 patients per experimental and 25.2 per control physician).

Interventions: Internists received 3 hours of training about how to help smokers quit. Physicians and their office staff also were given self-help booklets to distribute free to smokers and were urged to use a system of stickers on charts to remind physicians to counsel smokers about quitting.

Measurements and Main Results: On the basis of telephone interviews with patients after visiting the physician, we determined that internists who attended the Quit for Life program discussed smoking with more patients who smoked, spent more time counseling them about smoking, helped more patients set dates to quit smoking, gave out more self-help booklets, and made more follow-up appointments to discuss smoking than did internists in the control group. One year later, the rate of biochemically confirmed, long-term (≥ 9 months) abstinence from smoking was 1% higher among all patients of trained internists than among patients of controls (95% CI, -0.1% to -+2.3%), and 2.2% (+0.2% to +4.3%) higher among the patients who most wanted to quit smoking.

Conclusions: This continuing education program substantially changed the way physicians counseled smokers. As a result, a few more patients who wanted to quit smoking achieved long-term abstinence.





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