Helping Physicians Help Patients Quit Smoking

Over the next year, Dartmouth researchers will carry out a pilot study to determine if a new standardized protocol can help smokers with vascular disease quit smoking. The trial will be led by Philip Goodney, MD, an assistant professor of surgery at the Geisel School of Medicine and a researcher with The Dartmouth Institute for Health Policy and Clinical Practice (TDI), and Emily Spangler, MD, a resident in vascular surgery at Dartmouth-Hitchcock (DHMC). They were recently awarded a grant of $100,000 from the Society for Vascular Surgery to carry out the study.

Philip Goodney, MD

Philip Goodney, MD

“Patients who have vascular problems with blockages in their blood vessels commonly get those blockages because of cigarette smoking,” Goodney says. “So trying to get patients to quit smoking is an important part of our job.”

Previous research has found that vascular procedures have better outcomes when patients do not smoke, but the type and quality of smoking cessation counseling varies significantly from one physician to another. “Some physicians may spend a lot of time counseling patients; others don’t offer as much discussion,” Goodney says.

About a year and a half ago, Goodney became interested in developing best practices for smoking cessation counseling among vascular surgeons. Working with Spangler and Alik Farber, MD, a vascular surgeon at Massachusetts General Hospital (MGH), Goodney developed what they call the offer and report method. This protocol involves offering advice to patients about quitting smoking and then reporting those patients to a national hotline that will follow up with the patients, providing regular encouragement and counseling. The method also involves the use of nicotine replacement therapy, and it was based in part on the work of Nancy Rigotti, MD, a smoking cessation expert at MGH.

To find out whether offering this type of standardized counseling would improve quit rates among smokers with vascular disease, Goodney, Spangler, and Farber applied for a grant from the Society of Vascular Surgery. The award will allow them to carry out a small clinical trial. Four medical centers, including DHMC, will provide the offer and report protocol. Patients at four other medical centers will serve as controls by continuing to offer their current standard practice for smoking cessation.

Goodney hopes that “the systematic delivery of smoking cessation advice can increase the likelihood that the patient will be successful in quitting smoking.”

The study will include hospitals around the country with the aim of making the results generalizable. Once the data have been collected, Goodney and his colleagues plan to use that data to submit a proposal for a larger, federally funded trial.

Amos Esty

Amos Esty is a writer and editor in the Dartmouth College Office of Public Affairs.

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