MEDICAL STUDENT GUIDED SMOKING CESSATION COUNSELING FOR HOSPITALIZED PATIENTS: INFERENCES FROM A FOCUS GROUP DISCUSSION

Abstract

Therapeutic Area: CVD Prevention – Primary and Secondary Background: The MS-CHAT trial is a multi-center clinical trial that assessed the effectiveness of a medical student-guided smoking cessation program initiated in hospitalized patients. We observed a variation in motivation levels among students, with some students making up to 12 follow-up calls, while a few students dropped out of the trial. More information on what factors motivate and help students deliver effective counseling and what contributes to better outcomes among smokers would be beneficial. Methods: This is a qualitative descriptive study. Purposive sampling was used to recruit coordinators from 3 sites, medical students including those who dropped out from the trial, and PIs into 4 different FGDs. Participants completed a one-time audio-recorded FGD via Zoom. The questions were open-ended and data was analyzed using thematic analysis. Results: Factors that motivated patients included fear of further deterioration of health and a higher number of follow-up calls by students. Peer pressure, pessimism, and believing it was “too late” to benefit from quitting were associated with relapse. Most medical students found the initial training session helpful. Students felt confident counseling patients for other lifestyle modifications after the training. They felt that more frequent debriefing sessions in smaller groups would be beneficial and online sessions would be convenient. More in-person counseling sessions by coordinating with the patient's outpatient visit, and an ideal patient-student ratio of 2-3: 1 would be beneficial. The factors that contributed to the attrition of students from the trial were lack of time due to other obligations, lack of apparent incentives, non-receptiveness to calls from patients, and perception of lack of efficacy of counseling. The National Medical Commission (NMC) needs to be approached to incorporate counseling training into the undergraduate (UG) medical curriculum. Anticipated challenges are the logistics of training large groups of students while maintaining the quality of training and time constraints due to large patient volumes. Conclusions: The number of follow-up calls correlated with quit rates. More in-person counseling sessions would be beneficial. Approaching the NMC to incorporate this into the curriculum would be impactful since India is the second largest consumer of tobacco.