Medical Student Counselling for Hospitalized Patients Addicted to Tobacco: The MS-CHAT Trial

The adverse outcomes associated with tobacco use are well documented and include an increased risk of cardiovascular diseases, cancers, respiratory diseases, adverse effects in pregnancy and oral diseases. One-half of all smokers will die prematurely as a consequence of their tobacco use. Tobacco cessation substantially reduces the risk of death associated with smoking and interventions to quit smoking are both efficacious and cost-effective. Every hospitalisation provides an opportunity to perform these interventions. Counselling for smoking cessation needs to be started during the hospitalisation and should be continued for at least a month after discharge to be effective. To address the twin problems of inadequate medical student training and lack of systematic counselling of hospitalized smokers, we designed a study to implement a smoking cessation training module for medical students, which will include a component of practical training amongst hospitalized smokers. We hypothesise that this training module will simultaneously result in improved quit rates amongst hospitalized smokers and improve medical student knowledge and comfort with counselling.

MEDICAL STUDENT TRAINING:

Students at each site will sit through a workshop conducted by a psychiatrist educator. There will be a didactic lecture, followed bygroup role-playing scenarios for 1–2 hours (students split into pairs and enactdifferent scenarios), with peer and proctor feedback. Students who complete the workshop and test out using a questionnaire will be inducted into the trial.

PATIENT COUNSELLING:

Asite coordinator will be recruited separately and trained. He/she will approachall patients in medicine, cardiology and/or pulmonology wards, who are eligiblefor the study. Consented patients will be stratified based on the centre and randomly assigned tointervention and control arms. Participating medical students willoffer inpatient counselling to patients in the intervention arm once duringtheir hospitalisation (recommended duration of 15-20 minutes).

Pharmacotherapy:

Medical students are allowed to decide if their patients are eligible forNicotine Replacement Therapy (nicotine gum and/or patch). These products can bepurchased from the local pharmacy upon discharge after approval by theattending physician/resident involved in the patient’s care. Patients will beadvised not to use the gum or patch until after the quit date.

 Follow up:

Students will then follow up with their patients and provide telephonecounselling (a minimum of 3 sessions of 15 mins each over 2 months). At eachsession, the student will assess the patient’s motivation and discuss relevantthemes. He/she will also maintain patient information in a workbook.

The control patients will not receive specialised counselling. For thesepatients, smoking cessation advice and referring to counselling are left at thediscretion of the treating physician. The number of patients counselled bytheir treating physician will be tracked throughout the study.