Skip to main content
PMC home page
Tobacco Control logoLink to Tobacco Control
. 2000 Dec;9(4):382–388. doi: 10.1136/tc.9.4.382

Patient recall versus physician documentation in report of smoking cessation counselling performed in the inpatient setting

J Nicholson 1, D Hennrikus 1, H Lando 1, M McCarty 1, J Vessey 1
PMCID: PMC1748402  PMID: 11106707

Abstract

OBJECTIVES—To determine rates of patient reported and physician documented counselling; to identify predictors of each report; and to identify the impact of each report on smoking cessation attempts after discharge from the hospital.
DESIGN—Stickers on subjects' charts prompted physicians to give brief smoking cessation counselling to patients in the hospital. Patients reported counselling received and quit attempts in a phone interview conducted 7-18 days after discharge. Rates of counselling and correlations were calculated, and multivariate analysis identified predictors of patient report, physician documentation, and quit attempts.
SETTING—Four hospitals in the Minneapolis/St Paul metropolitan area.
SUBJECTS—682 hospital patients who had smoked more than 100 cigarettes in their lifetime and had smoked in the last three months.
RESULTS—71.0% of patients reported counselling, and physicians documented counselling in the charts of 46.2% of patients (correlation = 0.15, κ = 0.13). Patient report was predicted by specific hospital, belief that their hospitalisation was smoking related, diagnosis of a smoking related disease, and physician documentation of counselling. Physician documentation was predicted by female patient, specific hospital, longer hospital stay, and marginally predicted by smoking related disease. Quit attempts were predicted by patient report of counselling, but not physician documentation.
CONCLUSIONS—Physicians document counselling in the hospital at a lower rate than patients report it, and the correlation between reports is very low, making an accurate assessment of true rates of counselling difficult. While it is important to increase physician documentation, it is even more important to increase patient recall, as this is the only report that predicts a quit attempt.


Keywords: smoking cessation counselling; patient recall; physician documentation

Full Text

The Full Text of this article is available as a PDF (154.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anda R. F., Remington P. L., Sienko D. G., Davis R. M. Are physicians advising smokers to quit? The patient's perspective. JAMA. 1987 Apr 10;257(14):1916–1919. [PubMed] [Google Scholar]
  2. Brown J. B., Adams M. E. Patients as reliable reporters of medical care process. Recall of ambulatory encounter events. Med Care. 1992 May;30(5):400–411. doi: 10.1097/00005650-199205000-00003. [DOI] [PubMed] [Google Scholar]
  3. Cummings K. M., Giovino G., Sciandra R., Koenigsberg M., Emont S. L. Physician advice to quit smoking: who gets it and who doesn't. Am J Prev Med. 1987 Mar-Apr;3(2):69–75. [PubMed] [Google Scholar]
  4. Dickey L. L., Gemson D. H., Carney P. Office system interventions supporting primary care-based health behavior change counseling. Am J Prev Med. 1999 Nov;17(4):299–308. doi: 10.1016/s0749-3797(99)00083-5. [DOI] [PubMed] [Google Scholar]
  5. Emmons K. M., Goldstein M. G. Smokers who are hospitalized: a window of opportunity for cessation interventions. Prev Med. 1992 Mar;21(2):262–269. doi: 10.1016/0091-7435(92)90024-c. [DOI] [PubMed] [Google Scholar]
  6. Frank E., Winkleby M. A., Altman D. G., Rockhill B., Fortmann S. P. Predictors of physician's smoking cessation advice. JAMA. 1991 Dec 11;266(22):3139–3144. [PubMed] [Google Scholar]
  7. Friedman C., Brownson R. C., Peterson D. E., Wilkerson J. C. Physician advice to reduce chronic disease risk factors. Am J Prev Med. 1994 Nov-Dec;10(6):367–371. [PubMed] [Google Scholar]
  8. Gerbert B., Hargreaves W. A. Measuring physician behavior. Med Care. 1986 Sep;24(9):838–847. doi: 10.1097/00005650-198609000-00005. [DOI] [PubMed] [Google Scholar]
  9. Gilpin E. A., Pierce J. P., Johnson M., Bal D. Physician advice to quit smoking: results from the 1990 California Tobacco Survey. J Gen Intern Med. 1993 Oct;8(10):549–553. doi: 10.1007/BF02599637. [DOI] [PubMed] [Google Scholar]
  10. Goldstein M. G., Niaura R., Willey-Lessne C., DePue J., Eaton C., Rakowski W., Dubé C. Physicians counseling smokers. A population-based survey of patients' perceptions of health care provider-delivered smoking cessation interventions. Arch Intern Med. 1997 Jun 23;157(12):1313–1319. doi: 10.1001/archinte.157.12.1313. [DOI] [PubMed] [Google Scholar]
  11. Heatherton T. F., Kozlowski L. T., Frecker R. C., Fagerström K. O. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict. 1991 Sep;86(9):1119–1127. doi: 10.1111/j.1360-0443.1991.tb01879.x. [DOI] [PubMed] [Google Scholar]
  12. Miller N. H., Smith P. M., DeBusk R. F., Sobel D. S., Taylor C. B. Smoking cessation in hospitalized patients. Results of a randomized trial. Arch Intern Med. 1997 Feb 24;157(4):409–415. [PubMed] [Google Scholar]
  13. Mitchell P., Chapman S., Smith W. "Smoking is a major cause of blindness". Med J Aust. 1999 Aug 16;171(4):173–174. doi: 10.5694/j.1326-5377.1999.tb123591.x. [DOI] [PubMed] [Google Scholar]
  14. Neighbor W. E., Jr, Stoop D. H., Ellsworth A. Smoking cessation counseling among hospitalized smokers. Am J Prev Med. 1994 May-Jun;10(3):140–144. [PubMed] [Google Scholar]
  15. Ockene J. K., Hosmer D. W., Williams J. W., Goldberg R. J., Ockene I. S., Biliouris T., Dalen J. E. The relationship of patient characteristics to physician delivery of advice to stop smoking. J Gen Intern Med. 1987 Sep-Oct;2(5):337–340. doi: 10.1007/BF02596170. [DOI] [PubMed] [Google Scholar]
  16. Pbert L., Adams A., Quirk M., Hebert J. R., Ockene J. K., Luippold R. S. The patient exit interview as an assessment of physician-delivered smoking intervention: a validation study. Health Psychol. 1999 Mar;18(2):183–188. doi: 10.1037//0278-6133.18.2.183. [DOI] [PubMed] [Google Scholar]
  17. Prochaska J. O., DiClemente C. C. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983 Jun;51(3):390–395. doi: 10.1037//0022-006x.51.3.390. [DOI] [PubMed] [Google Scholar]
  18. Rethans J. J., Martin E., Metsemakers J. To what extent do clinical notes by general practitioners reflect actual medical performance? A study using simulated patients. Br J Gen Pract. 1994 Apr;44(381):153–156. [PMC free article] [PubMed] [Google Scholar]
  19. Rigotti N. A., Arnsten J. H., McKool K. M., Wood-Reid K. M., Pasternak R. C., Singer D. E. Efficacy of a smoking cessation program for hospital patients. Arch Intern Med. 1997 Dec 8;157(22):2653–2660. [PubMed] [Google Scholar]
  20. Robinson M. D., Laurent S. L., Little J. M., Jr Including smoking status as a new vital sign: it works! J Fam Pract. 1995 Jun;40(6):556–561. [PubMed] [Google Scholar]
  21. Shopland D. R. Tobacco use and its contribution to early cancer mortality with a special emphasis on cigarette smoking. Environ Health Perspect. 1995 Nov;103 (Suppl 8):131–142. doi: 10.1289/ehp.95103s8131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Stange K. C., Zyzanski S. J., Smith T. F., Kelly R., Langa D. M., Flocke S. A., Jaén C. R. How valid are medical records and patient questionnaires for physician profiling and health services research? A comparison with direct observation of patients visits. Med Care. 1998 Jun;36(6):851–867. doi: 10.1097/00005650-199806000-00009. [DOI] [PubMed] [Google Scholar]
  23. Ward J., Sanson-Fisher R. Accuracy of patient recall of opportunistic smoking cessation advice in general practice. Tob Control. 1996 Summer;5(2):110–113. doi: 10.1136/tc.5.2.110. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Wilson A., McDonald P. Comparison of patient questionnaire, medical record, and audio tape in assessment of health promotion in general practice consultations. BMJ. 1994 Dec 3;309(6967):1483–1485. doi: 10.1136/bmj.309.6967.1483. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Tobacco Control are provided here courtesy of BMJ Publishing Group

RESOURCES