Cornuz Jacques, Humair Jean-Paul, Seematter Laurence, Stoianov Rebecca, van Melle Guy, Stalder Hans, Pécoud Alain
Lausanne University Outpatient Clinic and Institute of Social and Preventive Medicine, Lausanne, Switzerland.
Ann Intern Med. 2002 Mar 19;136(6):429-37. doi: 10.7326/0003-4819-136-6-200203190-00006.
New educational programs must be developed to improve physicians' skills and effectiveness in counseling patients about smoking cessation.
To assess the efficacy of an educational program based on behavioral theory, active learning methods, and practice with standardized patients in helping patients abstain from smoking and changing physicians' counseling practices.
Cluster randomized, controlled trial.
Two general internal medicine clinics in Switzerland.
35 residents and 251 consecutive smoking patients.
A training program administered over two half-days, during which physicians learned to provide counseling that matched smokers' motivation to quit and practiced these skills with standardized patients acting as smokers at different stages of change. The control intervention was a didactic session on management of dyslipidemia.
Self-reported abstinence from smoking at 1 year of follow-up, which was validated by exhaled carbon monoxide testing at one clinic; score of overall quality of counseling based on use of 14 counseling strategies; patient willingness to quit; and daily cigarette consumption.
At 1 year of follow-up, abstinence from smoking was significantly higher in the intervention group than in the control group (13% vs. 5%; P = 0.005); this corresponded to a cluster-adjusted odds ratio of 2.8 (95% CI, 1.4 to 5.5). Residents who received the study training provided better counseling than did those who received the control training (mean score, 4.0 vs. 2.7; P = 0.002). Smokers' willingness to quit was also higher in the intervention group (94% vs. 80%; P = 0.007). A nonsignificant trend toward lower daily cigarette consumption in the intervention group was observed.
A training program in smoking cessation administered to physicians that was based on behavioral theory and practice with standardized patients significantly increased the quality of physicians' counseling, smokers' motivation to quit, and rates of abstinence from smoking at 1 year.
必须开发新的教育项目，以提高医生在为患者提供戒烟咨询方面的技能和效果。
评估一个基于行为理论、主动学习方法以及与标准化患者练习的教育项目，在帮助患者戒烟和改变医生咨询行为方面的效果。
整群随机对照试验。
瑞士的两家普通内科诊所。
35名住院医师和251名连续就诊的吸烟患者。
一个为期两个半天的培训项目，在此期间医生学习提供与吸烟者戒烟动机相匹配的咨询，并与扮演处于不同改变阶段吸烟者的标准化患者练习这些技能。对照干预是关于血脂异常管理的讲授课程。
随访1年时自我报告的戒烟情况，在一家诊所通过呼出一氧化碳检测进行验证；基于14种咨询策略使用情况的咨询总体质量评分；患者戒烟意愿；以及每日吸烟量。
随访1年时，干预组的戒烟率显著高于对照组（13%对5%；P = 0.005）；这对应整群调整后的比值比为2.8（95%可信区间，1.4至5.5）。接受研究培训的住院医师提供的咨询比接受对照培训的住院医师更好（平均评分，4.0对2.7；P = 0.002）。干预组吸烟者的戒烟意愿也更高（94%对80%；P = 0.007）。观察到干预组每日吸烟量有降低的非显著趋势。
对医生实施的基于行为理论和与标准化患者练习的戒烟培训项目，显著提高了医生咨询的质量、吸烟者的戒烟动机以及1年时的戒烟率。
