Department of Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, USA.
BMC Med Educ. 2017 Dec 11;17(1):249. doi: 10.1186/s12909-017-1069-y.
Although brief cessation advice from healthcare professionals increases quit rates, smokers typically do not get this advice during hospitalisation, possibly due to resource issues, lack of training and professionals' own attitudes to providing such counselling. Medical students are a potentially untapped resource who could deliver cessation counselling, while upskilling themselves and changing their own attitudes to delivering such advice in the future; however, no studies have investigated this. We aimed to determine if brief student-led counselling could enhance motivation to quit and smoking cessation behaviours among hospitalised patients.
A mixed-methods, 2-arm pilot feasibility randomised controlled trial with qualitative process evaluation enrolled 67 hospitalised adult smokers, who were recruited and randomized to receive a brief medical student-delivered cessation intervention (n = 33) or usual care (n = 34); 61 medical students received standardised cessation training and 33 were randomly assigned to provide a brief in-hospital consultation and follow-up support by phone or in-person one week post-discharge. Telephone follow-up at 3- and 6-months assessed scores on the Motivation to Stop Smoking Scale (MTSS; primary outcome) and several other outcomes, including 7-day point prevalent abstinence, quit attempts, use of cessation medication, and ratings of student's knowledge and efficacy. Data were analysed as intention to treat (ITT) using penalised imputation, per protocol, and random effects repeated measures. Focus group interviews were conducted with students post-intervention to elicit their views on the training and intervention process.
Analyses for primary and most secondary outcomes favoured the intervention group, although results were not statistically significant. Point prevalence abstinence rates were significantly higher for the intervention group during follow-up for all analyses except 6-month ITT analysis. Fidelity was variable. Patients rated students as being "very" knowledgeable about quitting and "somewhat" helpful. Qualitative results showed students were glad to deliver the intervention; were critical of current cessation care; felt constrained by their inability to prescribe cessation medications and wanted to include cessation and other behavioural counselling in their normal history taking.
It appears feasible for medical students to be smoking cessation interventionists during their training, although their fidelity to the intervention requires further investigation. A definitive trial is needed to determine if medical students are effective cessation counsellors and if student-led intervention could be tailored for other health behaviours.
NCT02601599 (retrospectively registered 1 day after first participant recruited on November 3rd 2015).
尽管医护人员提供简短的戒烟建议可以提高戒烟率，但在住院期间，吸烟者通常无法获得此类建议，这可能是由于资源问题、缺乏培训以及专业人员自身对提供此类咨询的态度所致。医学生是一个潜在的未开发资源，他们可以提供戒烟咨询，同时提高自己的技能，并在未来改变自己提供此类建议的态度；然而，目前还没有研究调查过这一点。我们旨在确定由学生主导的简短咨询是否可以增强住院患者戒烟的动力并促进其戒烟行为。
一项采用混合方法、2 臂、试点可行性随机对照试验，结合定性过程评估，共纳入 67 名住院成年吸烟者。他们被招募并随机分配接受由医学生提供的简短戒烟干预（n=33）或常规护理（n=34）；61 名医学生接受了标准化的戒烟培训，其中 33 名学生被随机分配在出院后一周内通过电话或亲自提供简短的住院咨询和后续支持。在 3 个月和 6 个月时通过电话进行随访，评估动机戒烟量表（MTSS；主要结局）和其他几个结局的得分，包括 7 天点现患戒烟率、戒烟尝试、使用戒烟药物以及学生知识和效能评分。采用惩罚插补、意向治疗（ITT）和随机效应重复测量法分析数据。在干预后对学生进行焦点小组访谈，以了解他们对培训和干预过程的看法。
主要和大多数次要结局的分析均有利于干预组，尽管结果无统计学意义。除了 6 个月的 ITT 分析之外，在所有分析中，干预组在随访期间的点现患戒烟率均显著更高。一致性存在差异。患者对学生的戒烟知识评价为“非常”了解，对学生的帮助评价为“有些”。定性结果表明，学生很高兴提供干预措施；对目前的戒烟护理持批评态度；由于无法开具戒烟药物而感到受限，并希望将戒烟和其他行为咨询纳入其常规病史记录中。
医学生在培训期间似乎可以成为戒烟干预者，尽管他们对干预的一致性需要进一步调查。需要进行一项确定性试验来确定医学生是否是有效的戒烟咨询师，以及学生主导的干预是否可以针对其他健康行为进行定制。
NCT02601599（在 2015 年 11 月 3 日首次招募参与者后的第 1 天，即前瞻性注册）。
