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Consultations for cervical smears in general practice: a missed opportunity for smoking cessation advice?
  1. MELISSA HOBBS
  1. Needs Assessment & Health Outcomes Unit
  2. Central Sydney Area Health Service, Locked Bag 8
  3. Newtown, New South Wales 2042, Australia.
  4. mhobb{at}nah.rpa.cs.nsw.gov.au
  5. Needs Assessment & Health Outcomes Unit
  6. jward{at}nah.rpa.cs.nsw.gov.au
  7. Centre for Clinical Epidemiology and Biostatistics
  8. Royal Newcastle Hospital, Newcastle
  9. New South Wales, Australia.
  10. Needs Assessment & Health Outcomes Unit
    1. JEANETTE WARD
    1. Needs Assessment & Health Outcomes Unit
    2. Central Sydney Area Health Service, Locked Bag 8
    3. Newtown, New South Wales 2042, Australia.
    4. mhobb{at}nah.rpa.cs.nsw.gov.au
    5. Needs Assessment & Health Outcomes Unit
    6. jward{at}nah.rpa.cs.nsw.gov.au
    7. Centre for Clinical Epidemiology and Biostatistics
    8. Royal Newcastle Hospital, Newcastle
    9. New South Wales, Australia.
    10. Needs Assessment & Health Outcomes Unit
      1. KATE D’ESTE
      1. Needs Assessment & Health Outcomes Unit
      2. Central Sydney Area Health Service, Locked Bag 8
      3. Newtown, New South Wales 2042, Australia.
      4. mhobb{at}nah.rpa.cs.nsw.gov.au
      5. Needs Assessment & Health Outcomes Unit
      6. jward{at}nah.rpa.cs.nsw.gov.au
      7. Centre for Clinical Epidemiology and Biostatistics
      8. Royal Newcastle Hospital, Newcastle
      9. New South Wales, Australia.
      10. Needs Assessment & Health Outcomes Unit
        1. NEIL DONNELLY
        1. Needs Assessment & Health Outcomes Unit
        2. Central Sydney Area Health Service, Locked Bag 8
        3. Newtown, New South Wales 2042, Australia.
        4. mhobb{at}nah.rpa.cs.nsw.gov.au
        5. Needs Assessment & Health Outcomes Unit
        6. jward{at}nah.rpa.cs.nsw.gov.au
        7. Centre for Clinical Epidemiology and Biostatistics
        8. Royal Newcastle Hospital, Newcastle
        9. New South Wales, Australia.
        10. Needs Assessment & Health Outcomes Unit

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          Editor,—Consultations in general practice in which cervical smears are performed typically include more than one problem per encounter.1 Other than an earlier needs assessment involving consultations conducted by 23 trainees,2 no Australian studies have examined the provision of health promotion advice during consultations scheduled for a cervical smear. As the risks of cervical intraepithelial neoplasia and cervical cancer are higher for women who smoke,3 the provision of smoking cessation advice would be especially opportune in these consultations.

          We invited general practitioners (GPs) in urban Sydney to register for a comprehensive quality assurance programme in cervical screening.4 As part of this program, each GP was provided with 20 consent forms and asked to approach a consecutive sample of women attending for a cervical smear to complete a follow-up survey. Women so agreeing returned a signed consent form to us directly and, upon receipt, we forwarded a nine-page questionnaire which included questions about the woman’s smoking status and her recall of smoking cessation advice during the consultation. Fourteen days after the initial questionnaire mailing, non-respondents were sent a reminder letter. Any remaining non-respondents were telephoned on day 35 and asked to return their questionnaire.

          Smoking status and general practitioner advice about smoking (n = 2050)

          Of 142 self-selecting GPs participating in the programme, 94 (66%) were female and 112 (79%) worked full-time. We received consent forms from 2297 women attending for a smear, of whom 2050 (89%) returned completed questionnaires (number per GP ranged from two to 20; median = 16; mode = 18). Of these, 477 (23.4%, 95% confidence interval = 21.6% to 25.2%) women were smokers. The provision of smoking cessation advice in consultations for a cervical smear was low (table). Smoking cessation advice was significantly more likely to be given to older women (χ2 = 5.4; df = 1; p for trend <0.001). There was no association between GP sex and the provision of smoking cessation advice, however (χ2 = 2.7; df = 1; p = 0.1).

          Our findings are cause for concern. Other studies have persistently demonstrated low rates of smoking cessation advice.5-7 As just over a third of smokers recalled being advised to quit, opportunities to provide such advice in consultations for cervical screening also are being missed. Although the representativeness of our self-selecting sample of GPs is unknown, it appears we have failed to engage all GPs in a concerted public health effort against tobacco, even within the context of a preventive health check up with a key target group—women.

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