The Emergency Department Action in Smoking Cessation (EDASC) Trial: Impact on Delivery of Smoking Cessation Counseling

Authors

  • David A. Katz MD, MSc,

    1. From the Departments of Medicine (DAK, MWV, JH), Emergency Medicine (AN), Epidemiology (DAK), Biostatistics (SLH), and Psychology (MWV), University of Iowa, Iowa City, IA; the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Hospital (DAK, MWV, JH, SJ, SLH), Iowa City, IA; the Department of Emergency Medicine, Iowa Methodist Medical Center (LB), Des Moines, IA; and the University of Michigan School of Nursing (MT), Ann Arbor, MI. Dr. Katz is a Core Investigator in the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Department of Veterans Affairs Medical Center, Iowa City, IA.
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  • Mark W. Vander Weg PhD,

    1. From the Departments of Medicine (DAK, MWV, JH), Emergency Medicine (AN), Epidemiology (DAK), Biostatistics (SLH), and Psychology (MWV), University of Iowa, Iowa City, IA; the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Hospital (DAK, MWV, JH, SJ, SLH), Iowa City, IA; the Department of Emergency Medicine, Iowa Methodist Medical Center (LB), Des Moines, IA; and the University of Michigan School of Nursing (MT), Ann Arbor, MI. Dr. Katz is a Core Investigator in the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Department of Veterans Affairs Medical Center, Iowa City, IA.
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  • John Holman MS,

    1. From the Departments of Medicine (DAK, MWV, JH), Emergency Medicine (AN), Epidemiology (DAK), Biostatistics (SLH), and Psychology (MWV), University of Iowa, Iowa City, IA; the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Hospital (DAK, MWV, JH, SJ, SLH), Iowa City, IA; the Department of Emergency Medicine, Iowa Methodist Medical Center (LB), Des Moines, IA; and the University of Michigan School of Nursing (MT), Ann Arbor, MI. Dr. Katz is a Core Investigator in the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Department of Veterans Affairs Medical Center, Iowa City, IA.
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  • Andrew Nugent MD,

    1. From the Departments of Medicine (DAK, MWV, JH), Emergency Medicine (AN), Epidemiology (DAK), Biostatistics (SLH), and Psychology (MWV), University of Iowa, Iowa City, IA; the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Hospital (DAK, MWV, JH, SJ, SLH), Iowa City, IA; the Department of Emergency Medicine, Iowa Methodist Medical Center (LB), Des Moines, IA; and the University of Michigan School of Nursing (MT), Ann Arbor, MI. Dr. Katz is a Core Investigator in the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Department of Veterans Affairs Medical Center, Iowa City, IA.
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  • Laurence Baker DO,

    1. From the Departments of Medicine (DAK, MWV, JH), Emergency Medicine (AN), Epidemiology (DAK), Biostatistics (SLH), and Psychology (MWV), University of Iowa, Iowa City, IA; the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Hospital (DAK, MWV, JH, SJ, SLH), Iowa City, IA; the Department of Emergency Medicine, Iowa Methodist Medical Center (LB), Des Moines, IA; and the University of Michigan School of Nursing (MT), Ann Arbor, MI. Dr. Katz is a Core Investigator in the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Department of Veterans Affairs Medical Center, Iowa City, IA.
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  • Skyler Johnson MS,

    1. From the Departments of Medicine (DAK, MWV, JH), Emergency Medicine (AN), Epidemiology (DAK), Biostatistics (SLH), and Psychology (MWV), University of Iowa, Iowa City, IA; the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Hospital (DAK, MWV, JH, SJ, SLH), Iowa City, IA; the Department of Emergency Medicine, Iowa Methodist Medical Center (LB), Des Moines, IA; and the University of Michigan School of Nursing (MT), Ann Arbor, MI. Dr. Katz is a Core Investigator in the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Department of Veterans Affairs Medical Center, Iowa City, IA.
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  • Stephen L. Hillis PhD,

    1. From the Departments of Medicine (DAK, MWV, JH), Emergency Medicine (AN), Epidemiology (DAK), Biostatistics (SLH), and Psychology (MWV), University of Iowa, Iowa City, IA; the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Hospital (DAK, MWV, JH, SJ, SLH), Iowa City, IA; the Department of Emergency Medicine, Iowa Methodist Medical Center (LB), Des Moines, IA; and the University of Michigan School of Nursing (MT), Ann Arbor, MI. Dr. Katz is a Core Investigator in the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Department of Veterans Affairs Medical Center, Iowa City, IA.
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  • Marita Titler PhD, RN

    1. From the Departments of Medicine (DAK, MWV, JH), Emergency Medicine (AN), Epidemiology (DAK), Biostatistics (SLH), and Psychology (MWV), University of Iowa, Iowa City, IA; the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Hospital (DAK, MWV, JH, SJ, SLH), Iowa City, IA; the Department of Emergency Medicine, Iowa Methodist Medical Center (LB), Des Moines, IA; and the University of Michigan School of Nursing (MT), Ann Arbor, MI. Dr. Katz is a Core Investigator in the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Department of Veterans Affairs Medical Center, Iowa City, IA.
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  • Presented at the Society for Medical Decision Making annual meeting, Toronto, Ontario, Canada, October 2010.

  • Supported by the National Institute of Drug Abuse (R21 DA021607), Holden Comprehensive Cancer Center (Population Science Pilot Grant). This manuscript is the result of work supported in part with resources and the use of facilities at the Department of Veterans Affairs Medical Center, Iowa City, IA.

  • The authors have no potential conflicts of interest to disclose. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

  • Supervising Editor: Rochelle Fu, PhD.

Address for correspondence and reprints: David A. Katz, MD, MSc; e-mail: david-katz@uiowa.edu.

Abstract

ACADEMIC EMERGENCY MEDICINE 2012; 19: 409–420 © 2012 by the Society for Academic Emergency Medicine

Abstract

Objectives:  The focus on acute care, time pressure, and lack of resources hamper the delivery of smoking cessation interventions in the emergency department (ED). The aim of this study was to 1) determine the effect of an emergency nurse–initiated intervention on delivery of smoking cessation counseling based on the 5As framework (ask–advise–assess–assist–arrange) and 2) assess ED nurses’ and physicians’ perceptions of smoking cessation counseling.

Methods:  The authors conducted a pre–post trial in 789 adult smokers (five or more cigarettes/day) who presented to two EDs. The intervention focused on improving delivery of the 5As by ED nurses and physicians and included face-to-face training and an online tutorial, use of a charting/reminder tool, fax referral of motivated smokers to the state tobacco quitline for proactive telephone counseling, and group feedback to ED staff. To assess ED performance of cessation counseling, a telephone interview of subjects was conducted shortly after the ED visit. Nurses’ and physicians’ self-efficacy, role satisfaction, and attitudes toward smoking cessation counseling were assessed by survey. Multivariable logistic regression was used to assess the effect of the intervention on performance of the 5As, while adjusting for key covariates.

Results:  Of 650 smokers who completed the post-ED interview, a greater proportion had been asked about smoking by an ED nurse (68% vs. 53%, adjusted odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.3 to 2.9), assessed for willingness to quit (31% vs. 9%, adjusted OR= 4.9, 95% CI = 2.9 to 7.9), and assisted in quitting (23% vs. 6%, adjusted OR = 5.1, 95% CI = 2.7 to 9.5) and had arrangements for follow-up cessation counseling (7% vs. 1%, adjusted OR = 7.1, 95% CI = 2.3 to 21) during the intervention compared to the baseline period. A similar increase was observed for emergency physicians (EPs). ED nurses’ self-efficacy and role satisfaction in cessation counseling significantly improved following the intervention; however, there was no change in “pros” and “cons” attitudes toward smoking cessation in either ED nurses or physicians.

Conclusions:  Emergency department nurses and physicians can effectively deliver smoking cessation counseling to smokers in a time-efficient manner. This trial also provides empirical support for expert recommendations that call for nursing staff to play a larger role in delivering public health interventions in the ED.

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