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Response on e-cigarettes varied from doctor to doctor

E-Cigarettes

Washington D.C. [US]: A study finds physicians range greatly in their responses to patients in regard to e-cigarettes.

This study was done by researchers at the Stanford University School of Medicine who analysed more than 500 online interactions between patients and doctors discussing e-cigarettes.

“Researchers have previously surveyed doctors about their knowledge and attitudes concerning e-cigarettes. In this study, we were curious about actual provider behavior — the advice doctors gave in real patient interactions,” said the study’s senior author, Judith Prochaska.

“Within a novel online medical forum, we were able to observe the exact advice doctors were giving patients and see how that advice varied by topic and clinician,” Prochaska added.

The new observations have already helped inform the development of an educational portal, by Prochaska and colleagues, which aims to teach doctors what’s known about the health effects of e-cigarettes and how to communicate the benefits and risks of the devices to patients.

Available online through the Stanford Center for Continuing Medical Education, the interactive program provides clinicians with continuing medical education credits.

While traditional cigarettes deliver nicotine to a person’s body when they inhale burning tobacco, e-cigarettes work by heating up liquid until it vaporizes. E-cigarette use among both adults and teenagers has risen quickly in the decade since coming on the market.

According to the latest estimates from the U.S. Centers for Disease Control and Prevention, 3.7 percent of U.S. adults regularly use e-cigarettes. The devices are often promoted as safer than combustible cigarettes, and are also suggested as a smoking cessation aid, yet there’s little long-term evidence to support either assertion.

“There’s been rapid growth in the promotion and use of the products without an evidence base in terms of their safety and efficacy for tobacco cessation,” Prochaska said.

As e-cigarettes are so new, and so few studies have been conducted on them, physicians have little to rely upon when patients ask about the devices.

This is the reason Prochaska and her colleagues wondered what doctors typically said, and whether they conveyed that uncertainty.

“The big question for me, working in tobacco control, is what’s the best way for physicians to counsel their patients about electronic cigarettes,” said postdoctoral scholar Cati Brown-Johnson.

Prochaska and Brown-Johnson teamed up with researchers at HealthTap, an online health company that allows users to submit medical questions, which are answered by any of the 72,000 licensed physicians that work with the site.

“Outside of sitting and watching years of live interactions between patients and providers, this was really the best way for us to get data,” said Brown-Johnson.

When the scientists searched through all the anonymous questions posted on the site from July 2011 through June 2015, they identified almost 10,000 that related to tobacco or smoking. Of those, about 500 mentioned e-cigarettes — and the rate of e-cigarette-related questions increased over the four-year time period.

The most frequent themes brought up by physicians matched the most frequent concerns of patients: specific side effects and general safety.

But doctors also often brought up topics not mentioned by patients, including the need for more research on e-cigarettes and the relative safety of e-cigarettes compared with combusted tobacco. In addition, clinicians tended to mention nicotine more often than patients, often expressing specific concern about nicotine addiction.

“The existing research, however, does not indicate that e-cigarettes help people quit combustible cigarettes,” Prochaska said. “This is an area in need of greater study.”

When the researchers looked at how often patients thanked providers for their answers, they also spotted a trend: Most thanks were directed at doctors who had given a positive message about e-cigarettes.

“That finding is really interesting in thinking about how physicians might best connect with their patients,” said Brown-Johnson. “Doctors might consider conveying their information about e-cigarettes in a non-judgmental way, even when conveying the risks,” she said.

The study has been published in American Journal of Preventive Medicine. (ANI)

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