Medical student INtervention to promote effective nicotine dependence and tobacco HEalthcare (MIND-THE-GAP): single-centre feasibility randomised trial results

Anusha Kumar, Kenneth D Ward, Lisa Mellon, Miriam Gunning, Sinead Stynes, Anne Hickey, Ronán Conroy, Shane MacSweeney, David Horan, Graduate Entry Programme 2014-18 Class, Liam Cormican, Seamus Sreenan, Frank Doyle, Alice Fox, Justin Greco, Sean Harris, Elise Halpern, Cong Johnny Luo, Julie Peck, Alison Cameron-Vendrig, Adel Farah, Qasim Muhammad, Alexandra Mingay, Matthew Common, David Maj, Lorna Sampson Riden, Zhubene Mesbah, Carly Rabin, James Ulrich, Rehab Wali, Jodie Odame, Abhirami Anu Ananth, Katie Dunleavy, Jessica Suddaby, Jared Sheridan, Kam Sing Ho, Samuel Mihalcioiu, Andrew Mikhail, Celia Fernandez, Farah Adamali, Samantha Steinmetz-Wood, Michael Strader, Madeleine Sugar, Humraaz Samra, Rachel Dharamshi, Camille Tastenhoye, Orla Fitzpatrick, Catriona Harte Hayes, Lisa Ann Lawlor, David Horan, Ahmed F Hawwa, Sarah Lally, William Powell-Brett, Corry James O'Sullivan, Christian Ezeani, Andrew Redmond, Jessica Ennis, Florike Sheehan, Caroline Louise Anne O'Leary, Aoife Adelaide Gordon, Fearghal Martin Donnelly, Claire Drumm, Shane Karl Farrington, Aidan Alfred Mc Iver Bundy, Caroline Waddacor, Caroline Treacy, Sean Callinan, Gemma Wright Ballester, Dominic O'Dowd, Shona Reynolds, Francis Prendergast, Saoirse Ni Bhaoill, Anusha Kumar, Kenneth D Ward, Lisa Mellon, Miriam Gunning, Sinead Stynes, Anne Hickey, Ronán Conroy, Shane MacSweeney, David Horan, Graduate Entry Programme 2014-18 Class, Liam Cormican, Seamus Sreenan, Frank Doyle, Alice Fox, Justin Greco, Sean Harris, Elise Halpern, Cong Johnny Luo, Julie Peck, Alison Cameron-Vendrig, Adel Farah, Qasim Muhammad, Alexandra Mingay, Matthew Common, David Maj, Lorna Sampson Riden, Zhubene Mesbah, Carly Rabin, James Ulrich, Rehab Wali, Jodie Odame, Abhirami Anu Ananth, Katie Dunleavy, Jessica Suddaby, Jared Sheridan, Kam Sing Ho, Samuel Mihalcioiu, Andrew Mikhail, Celia Fernandez, Farah Adamali, Samantha Steinmetz-Wood, Michael Strader, Madeleine Sugar, Humraaz Samra, Rachel Dharamshi, Camille Tastenhoye, Orla Fitzpatrick, Catriona Harte Hayes, Lisa Ann Lawlor, David Horan, Ahmed F Hawwa, Sarah Lally, William Powell-Brett, Corry James O'Sullivan, Christian Ezeani, Andrew Redmond, Jessica Ennis, Florike Sheehan, Caroline Louise Anne O'Leary, Aoife Adelaide Gordon, Fearghal Martin Donnelly, Claire Drumm, Shane Karl Farrington, Aidan Alfred Mc Iver Bundy, Caroline Waddacor, Caroline Treacy, Sean Callinan, Gemma Wright Ballester, Dominic O'Dowd, Shona Reynolds, Francis Prendergast, Saoirse Ni Bhaoill

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Trial registration: NCT02601599 (retrospectively registered 1 day after first participant recruited on November 3rd 2015).

Keywords: Feasibility study; Medical students; Mixed methods; Randomised trial; Smoking.

Conflict of interest statement

Authors’ information

FD gave one (hopefully enthusiastic) lecture on smoking to the student class who participated as interventionists, which may have influenced the qualitative interviews.

Ethics approval and consent to participate

Ethics approval was provided by the Royal College of Surgeons in Ireland Research Ethics Committee (REC1126) and Connolly Hospital Research Ethics Committee (dated 2nd October 2015). All participants provided fully informed, written consent for participation, as did the students who participated in the focus groups.

Consent for publication

Not applicable.

Competing interests

FD gives one lecture on smoking to the students who participated. He has also accepted an honorarium from Abbvie for speaking on the topic of medication adherence. SS and FD obtained funding to conduct this study (see below). Other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Participant flowchart

References

    1. Services. USDoHaH: The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. In. Atlanta, GA; 2014.
    1. Hickey P, Evans DS. Smoking in Ireland 2014: synopsis of key patterns [Online]. In: HSE National Tobacco Control Office, Health and Wellbeing Division, Health Services Executive; 2015. Available from: . [Accessed 28 Nov 2017]
    1. Department of Health (Ireland). Tobacco Free Ireland Annual Report 2015 [Online]. 2017. Available from: . [Accessed: 28 Nov 2017].
    1. Bridgehead International. EQUIPP: Europe quitting: progress and pathways. London; 2011.
    1. Carson KV, Verbiest ME, Crone MR, Brinn MP, Esterman AJ, Assendelft WJ, Smith BJ. Training health professionals in smoking cessation. Cochrane Database Syst Rev. 2012;5:CD000214.
    1. Rigotti NA, Clair C, Munafo MR, Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev. 2012;5:CD001837.
    1. Rigotti NA, Regan S, Levy DE, Japuntich S, Chang Y, Park ER, Viana JC, Kelley JH, Reyen M, Singer DE. Sustained care intervention and postdischarge smoking cessation among hospitalized adults: a randomized clinical trial. JAMA : the journal of the American Medical Association. 2014;312(7):719–728. doi: 10.1001/jama.2014.9237.
    1. O'Donovan G. Smoking prevalence among qualified nurses in the Republic of Ireland and their role in smoking cessation. Int Nurs Rev. 2009;56(2):230–236. doi: 10.1111/j.1466-7657.2008.00700.x.
    1. Bartels C, Abuhaliga AR, McGee H, Morgan K, McElvaney NG, Doyle F. A survey of the prevalence of smoking and smoking cessation advice received by inpatients in a large teaching hospital in Ireland. Ir J Med Sci. 2012;181(3):445–449. doi: 10.1007/s11845-011-0792-3.
    1. Fitzpatrick P, Gilroy I, Doherty K, Corradino D, Daly L, Clarke A, Kelleher CC. Implementation of a campus-wide Irish hospital smoking ban in 2009: prevalence and attitudinal trends among staff and patients in lead up. Health Promot Int. 2009;24(3):211–222. doi: 10.1093/heapro/dap020.
    1. Ohakim A, Mellon L, Jafar B, O'Byrne C, McElvaney NG, Cormican L, McDonnell R, Doyle F. Smoking, attitudes to smoking and provision of smoking cessation advice in two teaching hospitals in Ireland: do smoke-free policies matter? Health Psychology and Behavioral Medicine: An Open Access Journal. 2015;3(1):142–153. doi: 10.1080/21642850.2015.1026347.
    1. Mellon L, McElvaney NG, Cormican L, Hickey A, Conroy R, Ekpotu L, Oghenejobo O, Atteih S, McDonnell R, Doyle F. Determining rates of smoking cessation advice delivered during hospitalisation and smoking cessation rates 3-months post discharge: a two-hospital survey. Health Psychology and Behavioral Medicine: An Open Access Journal. 2016;4(1):124–137. doi: 10.1080/21642850.2016.1190278.
    1. Raupach T, Shahab L, Baetzing S, Hoffmann B, Hasenfuss G, West R, Andreas S. Medical students lack basic knowledge about smoking: findings from two European medical schools. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2009;11(1):92–98. doi: 10.1093/ntr/ntn007.
    1. Raupach T, Merker J, Hasenfuss G, Andreas S, Pipe A. Knowledge gaps about smoking cessation in hospitalized patients and their doctors. European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology. 2011;18(2):334–341. doi: 10.1177/1741826710389370.
    1. Freund M, Campbell E, Paul C, McElduff P, Walsh RA, Sakrouge R, Wiggers J, Knight J. Smoking care provision in hospitals: a review of prevalence. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2008;10(5):757–774. doi: 10.1080/14622200802027131.
    1. Thomas S, Burke S, Barry S. The Irish health-care system and austerity: sharing the pain. Lancet. 2014;383(9928):1545–1546. doi: 10.1016/S0140-6736(14)60744-3.
    1. Card SE, Snell L, O'Brien B. Are Canadian general internal medicine training program graduates well prepared for their future careers? BMC Med Educ. 2006;6:56. doi: 10.1186/1472-6920-6-56.
    1. Triana AC, Olson MM, Trevino DB. A new paradigm for teaching behavior change: implications for residency training in family medicine and psychiatry. BMC Med Educ. 2012;12:64. doi: 10.1186/1472-6920-12-64.
    1. Rigotti NA. Training future physicians to deliver tobacco cessation treatment. J Gen Intern Med. 2016;31(2):144–146. doi: 10.1007/s11606-015-3560-7.
    1. Stolz D, Langewitz W, Meyer A, Pierer K, Tschudi P, S'Ng CT, Strobel W, Perruchoud AP, Fagerstrom K, Tamm M. Enhanced didactic methods of smoking cessation training for medical students--a randomized study. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2012;14(2):224–228. doi: 10.1093/ntr/ntr186.
    1. Ockene JK, Hayes RB, Churchill LC, Crawford SL, Jolicoeur DG, Murray DM, Shoben AB, David SP, Ferguson KJ, Huggett KN, et al. Teaching medical students to help patients quit smoking: outcomes of a 10-school randomized controlled trial. J Gen Intern Med. 2015;
    1. Rouse DN. Employing Kirkpatrick's evaluation framework to determine the effectiveness of health information management courses and programs. Perspect Health Inf Manag. 2011;8:1c.
    1. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P, Group C Methods and processes of the CONSORT group: example of an extension for trials assessing nonpharmacologic treatments. Ann Intern Med. 2008;148(4):W60–W66. doi: 10.7326/0003-4819-148-4-200802190-00008-w1.
    1. Negrini S. Application of the TIDieR checklist to improve understanding and replicability of studies in physical and rehabilitation medicine. Eur J Phys Rehabil Med. 2015;51(6):667–668.
    1. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687. doi: 10.1136/bmj.g1687.
    1. Bandura A. Health promotion from the perspective of social cognitive theory. Psychol Health. 1998;13:623–649. doi: 10.1080/08870449808407422.
    1. Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior: the Guildford press. 1991.
    1. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–1251. doi: 10.1016/0895-4356(94)90129-5.
    1. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire. Br J Addict. 1991;86(9):1119–1127. doi: 10.1111/j.1360-0443.1991.tb01879.x.
    1. Kotz D, Brown J, West R. Predictive validity of the motivation to stop scale (MTSS): a single-item measure of motivation to stop smoking. Drug Alcohol Depend. 2013;128(1–2):15–19. doi: 10.1016/j.drugalcdep.2012.07.012.
    1. Arora NK, Gustafson DH. Perceived helpfulness of physicians’ communication behavior and breast cancer patients’ level of trust over time. J Gen Intern Med. 2009;24(2):252–255. doi: 10.1007/s11606-008-0880-x.
    1. RALLOC: Stata module to design randomized controlled trials [].
    1. Freidman LM, Furberg CD, DL DM. fundamentals of clinical trials, 4th edition edn. New York: Springer; 2010.
    1. de Boer MR, Waterlander WE, Kuijper LD, Steenhuis IH, Twisk JW. Testing for baseline differences in randomized controlled trials: an unhealthy research behavior that is hard to eradicate. Int J Behav Nutr Phys Act. 2015;12:4. doi: 10.1186/s12966-015-0162-z.
    1. Barnes SA, Larsen MD, Schroeder D, Hanson A, Decker PA. Missing data assumptions and methods in a smoking cessation study. Addiction. 2010;105(3):431–437. doi: 10.1111/j.1360-0443.2009.02809.x.
    1. Yang X, Shoptaw S. Assessing missing data assumptions in longitudinal studies: an example using a smoking cessation trial. Drug Alcohol Depend. 2005;77(3):213–225. doi: 10.1016/j.drugalcdep.2004.08.018.
    1. Katz DA, Holman JE, Nugent AS, Baker LJ, Johnson SR, Hillis SL, Tinkelman DG, Titler MG, Vander Weg MW. The emergency department action in smoking cessation (EDASC) trial: impact on cessation outcomes. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2013;15(6):1032–1043. doi: 10.1093/ntr/nts219.
    1. Braun V, Clarke C. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. doi: 10.1191/1478088706qp063oa.
    1. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CP, Squiers L, Fabrizio C, et al. How we design feasibility studies. Am J Prev Med. 2009;36(5):452–457. doi: 10.1016/j.amepre.2009.02.002.
    1. Eldridge SM, Lancaster GA, Campbell MJ, Thabane L, Hopewell S, Coleman CL, Bond CM. Defining feasibility and pilot studies in preparation for randomised controlled trials: development of a conceptual framework. PLoS One. 2016;11(3):e0150205. doi: 10.1371/journal.pone.0150205.
    1. Higgs B. Promoting integrative learning in first-year science. In: Higgs B, McCarthy M, editors. EMERGING ISSUES II: The Changing Roles and Identities of Teachers and Learners in Higher Education. Cork: NAIRTL, University College Cork; 2008.
    1. Doyle F, Doherty S, Morgan K, McBride O, Hickey A. Understanding communication of health information: a lesson in health literacy for junior medical and physiotherapy students. J Health Psychol. 2013;18(4):498–507. doi: 10.1177/1359105312446771.
    1. Chisholm A, Mann K, Peters S, Hart J. Are medical educators following general medical council guidelines on obesity education: if not why not? BMC Med Educ. 2013;13:53. doi: 10.1186/1472-6920-13-53.
    1. Heckman CJ, Egleston BL, Hofmann MT. Efficacy of motivational interviewing for smoking cessation: a systematic review and meta-analysis. Tob Control. 2010;19(5):410–416. doi: 10.1136/tc.2009.033175.

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