title: Smoking cessation counseling in vascular surgical practice using the results of interviews and focus groups in the Vascular Surgeon offer and report smoking cessation pilot trial.
abstract: OBJECTIVE
  Although smoking cessation is a key priority emphasized by professional societies and multidisciplinary consensus guidelines, significant variation exists in the methods and efficacy of smoking cessation treatment practiced by vascular surgeons. We conducted a series of patient, surgeon, and nonpatient stakeholder focus groups to identify important domains for establishment of a successful smoking cessation program.
  
  
  METHODS
  As part of a planning effort for a randomized clinical trial on usual care vs a standardized, evidence-based smoking cessation intervention, our group performed a series of interviews and focus groups. These were four 1-hour interviews, conducted with stakeholders such as tobacco cessation counselors (n = 2), a Quit Line representative (n = 1), and a Vascular Quality Initiative leader (n = 1), as well as two 90-minute, formal, professionally moderated focus groups, one with vascular surgeons (n = 7), and another with patients (n = 4). Transcripts and audio recordings were qualitatively reviewed for themes to establish the most important domains perceived to be associated with a successful smoking cessation program.
  
  
  RESULTS
  Patients emphasized four domains critical for a successful smoking cessation program: the motivation to quit, an individualized approach, the timing of an intervention, and the tone of the physician who offers counseling. Although surgeons and nonpatient stakeholders also emphasized the importance of a compassionate physician tone, surgeons and nonpatient stakeholders differed from patients in their remaining domains. They emphasized the feasibility of a brief intervention in a busy clinical practice, implementation of the effort, and necessary infrastructure for smoking cessation programs. All focus group participants described a brief, evidence-based smoking cessation intervention as feasible in routine vascular practice.
  
  
  CONCLUSIONS
  Differences in motivation and significance exist for patients, surgeons, and stakeholders when they considered the specific domains most important in building a successful smoking cessation program. Despite these differences, all parties involved agreed that a brief, standardized intervention can be successful delivered in a busy vascular clinic setting.
authors.affiliation: Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH. Electronic address: karina.a.newhall@hitchcock.org.
authors.forename: Karina
authors.initials: K
authors.lastname: Newhall
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Mary
authors.initials: M
authors.lastname: Burnette
authors.affiliation: Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Brooke
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: Andres
authors.initials: A
authors.lastname: Schanzer
authors.affiliation: Department of Vascular Surgery, Louisiana State University Medical Center, New Orleans, La.
authors.forename: TzeWoei
authors.initials: T
authors.lastname: Tan
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Susan
authors.initials: S
authors.lastname: Flocke
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, Mass.
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
authors.affiliation: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Philip
authors.initials: P
authors.lastname: Goodney
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003376:Counseling; D003695:Delivery of Health Care; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010353:Patient Education as Topic; D010361:Patients / Q000523:psychology*; D010819:Physician's Role; D010817:Physician-Patient Relations; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D066231:Surgeons / Q000523:psychology*; D013997:Time Factors; D014481:United States; D014652:Vascular Diseases / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects