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OBJECTIVES:
While smoking cessation is a key priority emphasized by professional societies and multidisciplinary consensus guidelines, significant variation exists in the methods and efficacy of smoking cessation treatment practiced by vascular surgeons. We conducted a series of patient, surgeon, and non-patient stakeholder focus groups to identify important domains for establishing a successful smoking cessation program.
METHODS:
As part of a planning effort for a randomized clinical trial comparing usual care versus a standardized, evidence-based smoking cessation intervention, our group performed a series of interviews and focus groups. These were four one-hour interviews, conducted with stakeholders such as tobacco cessation counselors (n=2), a quit line representative (n=1), and a Vascular Quality Initiative (VQI) leader (n=1), as well as two 90-minute, formal, professionally moderated focus groups one with vascular surgeons (n=7), and another with patients (n=4). Transcripts and audio recordings were qualitatively reviewed for themes to establish the most important domains perceived to be associated with a successful smoking cessation program.
RESULTS:
Patients emphasized four domains critical for successful smoking cessation: the motivation to quit, an individualized approach, the timing of an intervention, and the tone of the physician offering counseling. While surgeons and non-patient stakeholders also emphasized the importance of a compassionate physician tone, surgeons and non-patient stakeholders differed from patients in their remaining domains. They emphasized the feasibility of a brief intervention in a busy clinical practice, implementation of the effort, and necessary infrastructure for smoking cessation programs. All focus group participants described a brief, evidence-based smoking cessation intervention as feasible in routine vascular practice.
CONCLUSIONS:
Differences in motivation and significance exist for patients, surgeons and stakeholders when considering the specific domains most important in building a successful smoking cessation program. Despite these differences, all parties involved agreed that a brief, standardized intervention can be successful delivered in a busy vascular clinic setting.

Patient Domains of Successful Smoking Cessation and Key Quotes

Domain	Key Quote from patient
Patient Motivation	“The cigarettes are more of a priority than anything. Until you change the priority, it’s not going to change anything.”
Physician tone in counseling	“You’re telling this guy he’s going to have his leg cut off and he’s got all these problems and ‘If you don’t put the damn cigarette down, that’s the problem.’ That’s not the way.”
Individualized program	“Hey, how do you feel about this and this?” instead of handing them a booklet saying, “Fill this out.”
Timing of the attempt	“If the blood’s running good and everything’s going great and the surgery went fine, now if I quit smoking⋯ it’s going to prolong it happening again and for me, that was the time to say, okay, he’s done everything he could do.”