Majority of US doctors discussing electronic cigarettes with their patients

A new survey of US doctors reveals they are frequently discussing electronic cigarettes (e-cigs) with patients in a clinical setting. A substantial proportion of physicians also recommend e-cigs to their patients who smoke despite some controversy around the devices.

Over 70% of the more than 560 physicians who participated in the written survey indicated that e-cigs can help patients reduce or eliminate smoking, and nearly half said that they believe e-cigs can reduce risk. Physicians are less likely to recommend e-cigs as a way to quit smoking.

The use of e-cigs for treatment is contentious, as there is currently limited evidence to support their efficacy and safety for smoking reduction or cessation.

Approximately two-thirds of the physician respondents report their patients who smoke ask them about e-cigs at least some of the time, and 58% report they ask their patients who smoke about using e-cigs at least some of the time. Overall, 85% of physicians report frequently advising their patients who smoke to quit, and approximately two-thirds frequently provide assistance in helping patients to quit. Some 38% of doctors surveyed have at some point recommended e-cigs to their patients who smoke.

If asked by patients whether or not they would recommend e-cigs to quit smoking, 30% would endorse this approach and 21% would definitively recommend against it. When asked if they would recommend e-cigs to reduce smoking, however, the proportion of physicians who would endorse this approach increased to 37%.

Practices and attitudes differed according to physician specialty. Surgical care providers appear less confident and reported less self-efficacy in the realm of general smoking cessation, as well as with e-cigs. Surgical providers also were less likely than primary care providers or pulmonologists to endorse outright the use of electronic cigarettes for their patients. Concerns by surgeons and anaesthesiologists about the potential effects of nicotine itself on surgical wound healing and other outcomes may explain this greater skepticism. Respondents in this field were more likely to endorse their use as a reduction strategy as compared to a smoking cessation tool.

The current study shows that in the midst of the uncertain and conflicting literature and guidelines on e-cigs, few physicians are actively recommending against these products. The majority of physician respondents are not confident either in their knowledge of e-cigs or in their ability to answer patient questions about these products.

"This study shows that, across the United States, physician are discussing electronic cigarettes with their patients who smoke. Despite limited evidence these products are effective for smoking cessation or are safe for long term use, physicians appear to be tolerant of these products and some are recommending them. This information serves as a call to regulators and health policy authorities that electronic cigarettes are effectively being viewed and discussed as devices intended to treat nicotine addiction in clinics across the country. I am hopeful that efforts will continue to ensure that these products are manufactured in a safe and standardized manner and that more detailed evidence based guidelines emerge to help clinicians as they continue to work with their patients." says Andrew S. Nickels, MD, assistant professor of medicine and paediatrics at Vanderbilt University Medical Center.