Björk Joar, Juth Niklas, Lynøe Niels
Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.
Department of Research and Development, Region Kronoberg, Sigfridsvägen 5, 352 57, Växjö, Sweden.
BMC Med Ethics. 2018 Jan 8;19(1):2. doi: 10.1186/s12910-017-0237-2.
In many countries, there are health care initiatives to make smokers give up smoking in the peri-operative setting. There is empirical evidence that this may improve some, but not all, operative outcomes. However, it may be feared that some support for such policies stems from ethically questionable opinions, such as paternalism or anti-smoker sentiments. This study aimed at investigating the support for a policy of smoking cessation prior to surgery among Swedish physicians and members of the general public, as well as the reasons provided for this.
A random sample of general practitioners and orthopaedic surgeons (n = 795) as well as members of the general public (n = 485) received a mail questionnaire. It contained a vignette case with a smoking 57-year old male farmer with hip osteoarthritis. The patient had been recommended hip replacement therapy, but told that in order to qualify for surgery he needed to give up smoking four weeks prior to and after surgery. The respondents were asked whether making such qualifying demands is acceptable, and asked to rate their agreement with pre-set arguments for and against this policy.
Response rates were 58.2% among physicians and 53.8% among the general public. Of these, 83.9% and 86.6%, respectively, agreed that surgery should be made conditional upon smoking cessation. Reference to the peri-operative risks associated with smoking was the most common argument given. However, there was also strong support for the argument that such a policy is mandated in order to achieve long term health gains.
There is strong support for a policy of smoking cessation prior to surgery in Sweden. This support is based on considerations of peri-operative risks as well as the general long term risks of smoking. This study indicates that paternalistic attitudes may inform some of the support for peri-operative smoking cessation policies and that at least some respondents seem to favour a "recommendation strategy" vis-à-vis smoking cessation prior to surgery rather than a "requirement strategy". The normative reasons speak in favour of the "recommendation strategy".
在许多国家，都有医疗保健倡议促使吸烟者在围手术期戒烟。有实证证据表明，这可能会改善部分而非全部手术结局。然而，可能有人担心，对这类政策的一些支持源于存在伦理问题的观点，比如家长式作风或反吸烟者情绪。本研究旨在调查瑞典医生和普通公众对术前戒烟政策的支持情况以及给出的理由。
对全科医生和骨科医生（n = 795）以及普通公众（n = 485）进行随机抽样，向他们发放邮件调查问卷。问卷包含一个案例 vignette：一名57岁吸烟的男性农民患有髋骨关节炎。该患者被建议进行髋关节置换治疗，但被告知为了符合手术条件，他需要在手术前后四周戒烟。受访者被问及提出这样的资格要求是否可以接受，并要求对支持和反对该政策的预设论据的认同程度进行评分。
医生的回复率为58.2%，普通公众的回复率为53.8%。其中，分别有83.9%和86.6%的人同意手术应以戒烟为条件。提及吸烟相关的围手术期风险是最常见的论据。然而，对于该政策为实现长期健康收益而实施这一论据也有强烈支持。
在瑞典，对术前戒烟政策有强烈支持。这种支持基于对围手术期风险以及吸烟总体长期风险的考虑。本研究表明，家长式态度可能是对围手术期戒烟政策部分支持的依据，并且至少一些受访者似乎更倾向于针对术前戒烟采取“推荐策略”而非“要求策略”。规范性理由支持“推荐策略”。
