Exploring factors that influence the implementation of presurgical smoking cessation interventions: a cross-sectional survey

PURPOSE: We aimed to evaluate the level of implementation of health care professionals in helping patients undergoing surgery quit smoking using the Ask, Advise, Assess, Assist, and Arrange Follow-Up (5As) brief intervention model, and to identify the main barriers and facilitators affecting the implementation during preoperative visits at hospitals in Catalonia, Spain. METHODS: In a multicentre cross-sectional study, we administed an online survey to clinical health care professionals who perform preoperative visits (anesthesiologists, nurses, and psychologists). The main outcome variable was the implementation of 5As. We used the validated Knowledge, Attitudes, Behaviours, and Organization (KABO) questionnaire to assess barriers and facilitators. We performed univariate and bivariate analyses of the 5As and the KABO domains according to professional category and sociodemographic variables. We conducted multivariable analyses using generalized estimating equations controlling for covariates. RESULTS: The survey was completed by 216 professionals of 633 invited to participate (34.1%). Engagement was high in the categories Ask (median [interquartile range] 0-10 Likert scale score, 10.0 [9.0-10.0]) and Advise (7.5 [5.0-10.0]), but very low in Assist (1.0 [0.0-3.0]) and Arrange Follow-Up (0.0 [0.0-2.0]). "Individual skills" and "organizational support/resources" had significantly lower scores compared with other domains (Holm-adjusted P < 0.05), whereas "Individual commitment" and "Beliefs about patients' desire/readiness" had significantly higher scores. CONCLUSIONS: The level of implementation of smoking cessation in preoperative visits was poor. The main barriers detected were lack of knowledge and lack of resources and organizational support. Hospitals should promote strategies that address the main barriers identified and should apply interventions to help people quit smoking as a routine practice in preoperative visits.