Development of an Instrument to Document the 5A's for Smoking Cessation
Development of an Instrument to Document the 5A's for Smoking Cessation
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DOI：
10.1016/j.amepre.2009.04.027
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发表时间：
2009-09-01
影响因子：
5.5
通讯作者：
Casucci, Brad
中科院分区：
文献类型：
--
作者：
Lawson, Peter J.;Flocke, Susan A.;Casucci, Brad
背景：广泛推荐的短暂戒烟5A策略包括五项任务：询问、建议、评估、协助和安排。 5A 的评估仅限于病历审查和自我报告。使用观察数据，开发了一种评估 5A 完成率的工具。方法：5A 直接观察编码方案 (5A-DOC) 是使用已发布的 5A 指南开发的，并使用观察到的临床医生与患者的互动进行完善。开发样本包括 2000 年收集的 46 次吸烟者与医生就诊的录音 (n=5)。接下来将 5A-DOC 应用到 2005 年至 2008 年间 28 名医生的 131 次就诊的第二个样本。评估者间的可靠性进行了评估并报告了频率。分析于 2008 年完成。结果：三个观察结果决定了 5A-DOC 的发展：(1) 患者完成 5A 的任务； (2)某些通信动作同时完成多个5A的任务； (3)顺序很重要。识别每项任务的评估者间一致性为中等至优秀（kappa=0.58-1.0）。当确定吸烟状况后（询问，n=78），61% 的人进行了评估准备，50% 的人进行了协助。总之，73% 的人未能充分完成 5A。结论：在戒烟讨论中考虑患者活动对于准确掌握 5A 的完成程度至关重要。 5A-DOC 可应用于音频或文字记录数据，以可靠地评估 5A 的哪些任务已完成。 5A 的临床医生表现一般，研究结果表明临床医生培训应侧重于评估和该任务的时间安排，并与患者报告的准备情况保持一致。 (Am J Prev Med 2009;37(3):248-254) (C) 2009 美国预防医学杂志
Background: The widely recommended 5A's strategy for brief smoking cessation includes five tasks: Ask, Advise, Assess, Assist, and Arrange. Assessments of the 5A's have been limited to medical-record review and self-report. Using observational data, an instrument to assess the rate at which the 5A's are accomplished was developed.Methods: The 5A's Direct Observation Coding scheme (5A-DOC) was developed using published 5A's guidelines and was refined using observed clinician-patient interactions. The development sample consisted of 46 audio-recorded visits of smokers with their physician (n=5), collected in 2000. The 5A-DOC was next applied to a second sample of 131 visits with 28 physicians between 2005 and 2008. Inter-rater reliability was assessed and frequencies reported. Analyses were completed in 2008.Results: Three observations shaped the development of the 5A-DOC: (1) patients accomplish 5A's tasks; (2) some communication actions accomplish multiple 5A's tasks simultaneously; and (3) sequence is important. Inter-rater agreement for identifying each task was moderate to excellent (kappa=0.58-1.0). When smoking status was established (Ask, n=78), 61% Assessed readiness, and 50% contained Assist. In all, 73% failed to complete the 5A's adequately.Conclusions: Accounting for patient activity in smoking-cessation discussions is essential to accurately capture the degree to which the 5A's have been accomplished. The 5A-DOC can be applied to audio or transcript data to reliably assess which of the 5A's tasks have been accomplished. Clinician performance of the 5A's was modest, and findings suggest that clinician training should focus on Assess and the timing of this task, and alignment with patients' reported readiness. (Am J Prev Med 2009;37(3):248-254) (C) 2009 American Journal of Preventive Medicine