Ophthalmologists' and optometrists' attitudes and behaviours regarding tobacco cessation intervention
- Correspondence to: Dr Judith Gordon;
Although health care providers can be effective in motivating and helping patients to quit their tobacco use,1–7 the potential role of eye care professionals has been under recognised. Several chronic ocular diseases are associated with smoking,8 including formation of cataracts and age related macular degeneration (a leading cause of blindness).8,9 As a cardiovascular risk factor, smoking may also play a role in the development of anterior ischaemic optic neuropathy.10 In addition, smoking may increase the risk of ocular disease from other disorders, such as diabetes, the main cause of blindness in persons 20–74 years of age.11
Before developing a tobacco cessation intervention for eye care professionals, it is essential to assess the current status of tobacco cessation activities in routine eye care. We sent a 12 item questionnaire to all currently licensed ophthalmologists (n = 1209) and a random sample of 1234 optometrists in four western states of the USA (Arizona, California, Oregon, and Washington), assessing demographics and behaviours, attitudes, and barriers regarding intervention with tobacco using patients. The final return rate was 39% for ophthalmologists and 53% for optometrists. Data are presented only for those in current practice (90% of the ophthalmologists and 95% of the optometrists). Since ophthalmologists were significantly less likely to return the survey (χ2 (1, n = 2443) = 48.56, p < 0.001) than optometrists, we report data for each professional group separately without comparing the two.
As table 1 indicates, both ophthalmologists and optometrists feel it is appropriate to help tobacco using patients with cessation, though few do so regularly and many barriers are perceived. Optometrists employing support staff were more likely to express positive attitudes towards providing tobacco interventions than those who did not (t(634) = 2.55, p < 0.05), suggesting a correlation between time constraints and attitude toward intervention.
Both ophthalmologists and optometrists cited many barriers to intervening with their tobacco using patients. Lack of time was most commonly cited by ophthalmologists, whereas optometrists were more concerned about lack of patient materials and lack of training. How recently they trained and their sex were related to barriers. Ophthalmologists and optometrists who had graduated more recently from their programmes perceived fewer barriers to providing cessation services (r = 0.18, p < 0.01 for ophthalmologists; r = 0.16, p < 0.01 for optometrists). Previous studies1,12 have shown a reduction in perception of barriers due to receiving education in tobacco cessation intervention.
Surprisingly, female ophthalmologists were less likely to believe they should advise patients to quit (t(381) = 2.16, p < 0.05), and both female ophthalmologists and optometrists perceived more barriers to doing so (t(365) = −2.54, p < 0.05 for ophthalmologists, t(586) = −2.93, p < 0.01 for optometrists). This reluctance may be due to female eye care providers' concerns about possible negative patient reactions, or fears of losing patients from their practices.
Although this is a convenience sample, our results suggest the feasibility of brief, office based tobacco cessation interventions for use in eye care settings. An intervention must, however, focus on reducing perceived barriers by training eye care professionals in providing an effective, brief intervention that is readily received by patients, as well as providing resources and materials to practitioners. Our data suggest that cooperative agreements with insurance companies to provide reimbursement to providers would facilitate the adoption of the intervention.
As summarised by the Clinical Practice Guidelines,2 many types of general and specialist providers have successfully incorporated tobacco cessation activities into their practices. One way to extend the reach of tobacco cessation interventions is to utilise other medical specialists to motivate tobacco users to quit. Ophthalmology and optometry may provide such an opportunity, given the role of smoking in ocular disease, the fact that most visits are for routine rather than acute care, and the presence of support staff who can help implement an intervention.
Work supported in part by grant R01 CA71018 from the National Cancer Institute.