Training physicians and nurses to deliver evidence-based brief interventions for tobacco use and dependence: Differences pre-and post-training

Tobacco use is the leading cause of preventable death and disease in the U.S. Cessation provides major health benefits. The healthcare system is vital to the delivery of tobacco cessation services. The Public Health Service Clinical Practice Guideline for the Treatment of Tobacco Use and Dependence (Fiore, 2000) provides recommendations for treatment that can be implemented with minimal demands on providers, can increase quit rates, are cost-effective, and should be part of the routine care of every patient. However, providers currently are poor at implementation; Barriers include lack of knowledge, awareness, self-efficacy, and positive outcome expectancies all of which can be addressed by training. However, providers present with different professional backgrounds and may respond to training differently. From 1-2006 to 1-2007, physicians (n=122) and nurses (RN/APN=203) in Arkansas completed a 1-hour CE/CME-approved training. Tests were administered prior to and after training. Training successfully increased test results (paired-samples t-tests, all p.s < .01); however there were several significant differences between groups prior to training. Physicians reported more knowledge, confidence, perceived importance of treatment, and preparedness than nurses at baseline (p < .05). Post-training, there was only one difference. Nurses perceived treatment to be more effective (p < .01) after being trained. These results suggest that nurses may begin with a weaker foundation for providing treatment, but appear to reach a level comparable to MDs with training. Nurses also appear to more optimistic about the effectiveness of treatment post-training. Although training physicians is imperative, considerable benefit is derived from training nurses.