克服治疗孕期吸烟的挑战——澳大利亚全科医生障碍的定性研究。
Overcoming Challenges to Treating Tobacco use During Pregnancy - A Qualitative study of Australian General Practitioners Barriers.
机构信息
Centre for Brain & Mental Health Research, University of Newcastle, Callaghan, 2308, Australia.
The Wollotuka Institute, University of Newcastle, Callaghan, 2308, Australia.
出版信息
BMC Pregnancy Childbirth. 2019 Feb 7;19(1):61. doi: 10.1186/s12884-019-2208-8.
BACKGROUND
General practitioners can play an important role in addressing smoking among pregnant women but studies suggest they rarely do so. The aim of this study was to explore general practitioners perceptions about the management of smoking in pregnancy, and what would enable them to provide better care.
METHODS
Qualitative semi-structured interviews were conducted (Feb-July 2017), with 19 Australian general practitioners recruited from a sample that participated in a national survey on managing smoking during pregnancy; and through a national conference. The interview guide was structured using the theoretical domains framework, exploring previously reported barriers and two specific components of smoking cessation care - nicotine replacement therapy prescription and Quitline referral.
RESULTS
Participants reported high confidence and knowledge to provide pregnant patients adequate support for quitting. Nonetheless, participants reported lacking communication skills, focusing on providing information on smoking harm, accepting cutting down cigarettes as adequate, while following the 'Stages of Change' model and only providing treatment options to motivated patients. Lack of time, nicotine replacement therapy cost and safety concerns, and being unfamiliar with the Quitline (particularly for Aboriginal and Torres Strait Islander pregnant smokers) were perceived as challenges. Participants reported needing better communication skills, clear detailed nicotine replacement therapy guidelines for special populations, and visual resources they could use to discuss treatment options with patients.
CONCLUSIONS
Difficulty communicating with pregnant patients about smoking, using the 'Stages of Change' model to guide support provision and concerns regarding nicotine replacement therapy safety are barriers to providing cessation support to pregnant patients for general practitioners. Training on specific effective behaviour change techniques, clear guidance for nicotine replacement therapy use, and practical visual patient education tools may facilitate smoking cessation care provision to pregnant women.
背景
全科医生在解决孕妇吸烟问题方面可以发挥重要作用，但研究表明，他们很少这样做。本研究旨在探讨全科医生对妊娠期间吸烟管理的看法，以及使他们能够提供更好护理的因素。
方法
2017 年 2 月至 7 月期间，采用半结构式定性访谈法，对 19 名澳大利亚全科医生进行了访谈，这些医生来自参与全国妊娠期间管理吸烟情况调查的样本，以及通过全国会议招募而来。访谈指南使用理论领域框架构建，探讨了先前报告的障碍以及戒烟护理的两个特定组成部分 - 尼古丁替代疗法处方和戒烟热线转介。
结果
参与者报告说，他们有很高的信心和知识，能够为孕妇提供足够的戒烟支持。尽管如此，参与者报告缺乏沟通技巧，专注于提供吸烟危害的信息，接受减少吸烟作为足够的方法，同时遵循“改变阶段”模型，仅向有动力的患者提供治疗选择。缺乏时间、尼古丁替代疗法的成本和安全问题，以及对戒烟热线（特别是针对土著和托雷斯海峡岛民孕妇）不熟悉，被认为是挑战。参与者报告需要更好的沟通技巧、针对特殊人群的详细尼古丁替代疗法指南，以及他们可以用来与患者讨论治疗选择的视觉资源。
结论
全科医生在与孕妇就吸烟问题进行沟通、使用“改变阶段”模型来指导支持提供以及对尼古丁替代疗法安全性的担忧方面存在困难，这是为孕妇提供戒烟支持的障碍。针对特定有效的行为改变技术的培训、尼古丁替代疗法使用的明确指导以及实用的视觉患者教育工具，可能有助于为孕妇提供戒烟护理。
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