Health Care Providers' Views and Experiences with Smoking Cessation and Alternative Nicotine Products - Executive Summary

Prepared for: Health Canada
Supplier Name: Phoenix SPI
Contract Number: HT372-192432-001_CY
Contract Value: $174,669.58 (including HST)
Award Date: 2019-06-07
Delivery Date: 2019-10-12
Registration Number: POR 019-19

For more information on this report, please contact Health Canada at: hc.cpab.por-rop.dgcap.sc@canada.ca

Ce rapport est aussi disponible en français.

Executive Summary

Tobacco use is the leading cause of preventable death in Canada. It is a contributing factor to serious chronic diseases, such as cancer, respiratory ailments, and heart disease. In order to reduce the burden of disease and disability, the Government of Canada announced a target of less than 5% tobacco use by 2035.  The Strategy will feature broad, population-based approaches needed to achieve the ambitious target, and targeted approaches focussed on specific populations with high levels of tobacco use.

Health care providers (HCPs) are considered by Canadians as a credible source of information when seeking advice about health in general, as well as about quitting smoking. As such, they have a role to play in realizing this objective. The purpose of this research, therefore, was to quantify the knowledge, attitudes, behaviours, and perceptions among health care providers on smoking cessation and alternative nicotine products. The primary objective was to gather information on the perspectives and experiences of HCPs with respect to alternative nicotine products.

An online survey was administered to 1,125 HCPs between August 2 and August 30, 2019. To be eligible to complete the survey, HCPs needed to see patients who use tobacco products. The survey averaged 20 minutes to complete. The sample was drawn from SmartPoint Research’s online panel of HCPs. Panellists were invited to participate in the survey through an email invitation which contained a password-protected URL to access the survey. Survey data was weighted by region and profession using the Canadian Institute for Health Information’s (CIHI) Health Workforce data. Surveys that use samples drawn from online panels cannot be described as statistically projectable to the target population. No estimates of sampling error can be calculated because the sample is based on those who initially self-selected for participation in the panel.

Key findings include:

• Virtually all HCPs consider it important to discuss smoking cessation with patients who smoke.
  • There is virtual unanimity that it is at least somewhat important for health care providers to discuss smoking cessation with their patients who smoke cigarettes. Moreover, 78% of the health care providers surveyed believe that discussing smoking cessation with patients is very important.
• Nearly three-quarters of health care professionals believe that flagging a patient’s record for smoking status would prompt a discussion about smoking.
  • 52% of the HCPs surveyed say that their patients who smoke have a flag in their record file about their smoking status. Asked if such a flag does or would prompt a discussion about their patients’ smoking status, 73% said yes.
  • 49% of HCPs who flag the smoking status of patients in their files document a patient’s smoking status at every visit. Fewer (20%) schedule appointments with patients specifically to discuss their smoking status.
  • The likelihood of proactively scheduling appointments with patients varies greatly by type of practitioner: 49% of family/general practitioners proactively meet with patients to discuss smoking status compared to just 12% of specialists who reported doing so.
• Patients rarely raise the topic of smoking cessation with their health care provider. Health care providers are under the impression that patients are not receptive to advice about quitting smoking.
  • Frequent discussions with patients about smoking cessation are much more likely to be initiated by HCPs than their patients. Just 6% of HCPs say that their patients raise the topic of smoking cessation at every visit or almost every visit. 
  • Occasional discussions about smoking cessation are almost equally likely to be initiated by HCPs (37%) or their patients (39%).
  • The most frequently mentioned challenge in talking to patients about quitting smoking is the impression that patients are not receptive to receiving advice or help to quit.
• Many HCPs follow-up with patients once they start the process of quitting smoking.
  • Once patients have started the process of quitting smoking, 20% of HCPs follow-up at every visit, 30% at almost every visit, 4% annually, and 9% once only and then not again.
  • 21% said they never follow-up with patients once they start the process of quitting smoking.
• Stress is the main factor identified by patients to explain a smoking relapse.
  • Stress was the most frequently mentioned reason for a smoking relapse.Three-quarters of HCPs said that, when a patient relapses, they point to a stressful life event or stress in general as the reason for the relapse.
  • Other reasons mentioned by patients include having a spouse/partner or family member who still smokes (57%), depression or mental health (47%), and thinking they could smoke occasionally (38%).
• Just over three-quarters of HCPs do not consider using another product containing nicotine as successfully quitting smoking.
  • Fewer than one-quarter (23%) of HCPs would consider a patient to have successfully quit smoking if this patient completely switched from smoking cigarettes to using another product containing nicotine.
  • The main reason given by HCPs to explain why switching from smoking cigarettes to using another product containing nicotine would not be considered a successful quit attempt was that these patients are still dependent upon/addicted to nicotine.
• Health care providers are receiving more questions about vaping products now than a year ago. The main advice about vaping products health care providers give patients is that the long-term health effects of vaping products are unknown.
  • 54% of HCPs do not know what percentage of their patients use vaping products.
  • While 61% of HCPs said their patients rarely or never ask about vaping products, respondents were three times more likely to say that this is happening more often now than less often, compared to one year ago (31% versus 10%).
  • Two pieces of advice vis-à-vis vaping products were identified by a majority of HCPs: 67% advise patients that the long-term health effects of vaping are unknown, and 55% advise them of the potential risks and harms of vaping.
• Most HCPs reported a high degree of comfort talking to patients about smoking cessation and tobacco use.
  • 96% of HCPs are somewhat or very comfortable talking to patients about smoking cessation and 94% are somewhat or very comfortable talking to patients about tobacco use. Far fewer expressed comfort talking about vaping products: 20% are very comfortable and 35% are somewhat comfortable doing this.
• Vaping products with nicotine were perceived to be more harmful in comparison to vaping products without nicotine. Views on the health impact of quitting smoking and switching to vaping tend to be mixed.
  • 76% of HCPs believe that vaping products with nicotine are at least moderately harmful; just 53% believe this about vaping products without nicotine. 
  • 42% think that completely switching to vaping with nicotine from cigarettes will improve the health of a smoker a little (34%) or a lot (8%), while 60% think that switching to vaping without nicotine will improve the health of a smoker a little (36%) or a lot (24%).
• HCPs believe that tobacco should continue to be a high priority for the Government of Canada, and nearly half believe the health risk posed by tobacco has increased in recent years..
  • 9 in 10 HCPs think that tobacco should continue to be a high government priority.
  • Nearly half (47%) agree that the health risk to Canadians posed by tobacco has increased in the past five years.
• Health Canada is the main resource consulted by health care providers when searching for information about smoking cessation and vaping.
  • 75% of HCPs consult Health Canada for information about smoking cessation and 47% do so for information about vaping products.
  • Asked specifically which Health Canada resources, if any, they have consulted over the past few years, HCPs were most likely to access the general departmental website (43%), followed by Health Canada’s Quit Smoking Services and Information (31%), and Quit4Life (28%).

The contract value was $174,669.58 (including HST).

Political Neutrality Certification

I hereby certify, as a Senior Officer of Phoenix Strategic Perspectives, that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Communications Policy of the Government of Canada and Procedures for Planning and Contracting Public Opinion Research. Specifically, the deliverables do not contain any reference to electoral voting intentions, political party preferences, standings with the electorate, or ratings of the performance of a political party or its leader.

Signed:

Alethea Woods, President
Phoenix Strategic Perspectives Inc.