Brief smoking cessation interventions by family physicians in northwestern Ontario rural hospitals.

INTRODUCTION: We report on physicians' beliefs, confidence and clinical practice relative to the provision of smoking cessation interventions in northwestern (NW) Ontario, where tobacco use and tobacco-related disease prevalence are high and smoking cessation services are scarce. METHODS: Physicians working at the 12 rural hospitals in NW Ontario were eligible for inclusion in the study. Survey items included clinical practices based on the "5 A's" protocol for tobacco intervention, and beliefs about, confidence in, and barriers and facilitators to intervention. RESULTS: Physicians from 8 of the 12 hospitals responded. Almost all (> 91%) reported positive beliefs about providing smoking cessation interventions and were confident intervening. Relative to the 5 A's protocol for tobacco intervention, 100% of respondents ask, advise, assess and assist patients to quit smoking, and 89% arrange follow-up. The most frequent methods of assistance included pharmacotherapy, suggestions of specific actions to make it easier to quit and recommendations for alternatives to tobacco use. The most frequent barrier to intervenion was lack of time. DISCUSSION: Based on respondents' positive beliefs, confidence and current clinical practice relative to tobacco interventions, physicians in NW Ontario seem well positioned to play a key role in helping to reduce the high rates of tobacco use and tobacco-related diseases by providing smoking cessation interventions to patients who have been admitted to hospital.

Screening new cancer patients for psychological distress using the hospital anxiety and depression scale.

The diagnosis of a life-threatening illness creates immediate psychosocial distress for the patient and his or her family. The threat is real and the rational response is to be afraid. We need to be reaching out to patients and their families and not waiting for crises. The responsibility remains with the healthcare system and psychosocial healthcare professionals to identify those who are in most need. Psychological distress is something that can be relatively easily measured and responded to when psychosocial oncology healthcare professionals are immediately available to address those needs. This paper describes the process used to gather this information, how that information has been used by the psychosocial clinicians in the Supportive Care programme, and what we have learned, in terms of a retrospective data analysis, about our patient population. At the Cancer Centre in Thunder Bay, Ontario, Canada new cancer patients complete the HADS on the day of their first appointment. Since October 2000 we have collected baseline psychological distress data for 3,035 new cancer patients who fully completed all 14 items on the HADS. Of those, 781 patients, or 25.7%, scored above cut-off points and were given a telephone call. We were able to contact 607 (or 77.7%) of these patients. Five hundred and eight (or 83.7%) of those contacted made, and subsequently attended, one or more appointments with a psychosocial counsellor.