Dental Students’ Awareness, Preparedness and Barriers towards Managing Tobacco-Using Patients—A Cross-Sectional Study

Aims: To evaluate Hong Kong dental students’ perceived awareness, preparedness and barriers towards managing tobacco-using patients. Methods: A validated questionnaire was administered to dental students who were in their clinical years (the third, fourth, fifth and sixth year of study) in 2017 at the University of Hong Kong. The questionnaire consisted of three sections: (1) awareness towards practicing tobacco cessation counselling (TCC), (2) preparedness in terms of confidence, knowledge and clinical practices when managing tobacco-using patients, and (3) perceived barriers to counselling. Results: All 206 invited students had participated this study. Most (93%) agreed that dentists should deliver TCC. However, only around a quarter (26%) of students were well-prepared to help patients in tobacco cessation. While 60% of students agreed nicotine replacement therapy (NRT) was helpful for patients to quit tobacco use, only 28% understood its mechanism of action, and merely 16% were knowledgeable enough to introduce NRT to their patients. Two-thirds (62%) of students felt they did not have sufficient skills at this stage of their training. Conclusions: Most Hong Kong dental students had good awareness that dental professionals had an important role to promote tobacco cessation in their patient pools. However, not many of them were well-prepared to manage tobacco-using patients. Common barriers were found to be patients’ apathy and students’ inadequate familiarity with NRT.


Introduction
Background/rationale 2 Explain the scientific background and rationale for the investigation being reported 1-2 Objectives 3 State specific objectives, including any prespecified hypotheses 2

Study design 4
Present key elements of study design early in the paper 3

Pilot test of the questionnaire
The questionnaire was partly based on an earlier study by Murugaboopathy et al. (2013). Five dental students, who were with clinical experience and from other English-speaking countries, were recruited for pilot test. These students were not included in the main test. Advices of English editing were collected.
In the original questionnaire, to investigate the common practice of dental students managing smoker patients, questions set in section 2 (clinical practice when treating smoker patients) asked the respondents whether they had recorded the number of pack-year in patient record, the type of tobacco used. In addition, they were asked if they had made afford to assist patients to quit tobacco use. However, in the pilot testing of the questionnaire, we found out that not all dental students had smoker patients in their patient pool. Therefore, further amendment rather than the language editing was performed. In our finalized questionnaire, the same session was divided into two sub-sections asking different questions for those students who had smoker patients and those who had not. If they had smoker patients, they were asked about their actual clinical practice. Yet for those who did not have smoker patients, they were asked what they would do if they have smoker patients.
Dental students' awareness, preparedness and barriers towards managing tobacco-using patients 1. Views and confidence towards practicing tobacco cessation counselling Strongly agree Agree Neutral Disagree Strongly disagree I will advise patients to quit tobacco use in my future career I believe tobacco cessation counselling provided by dentists could assist patients to quit tobacco use I am confident in explaining the negative impacts of tobacco usage on oral health I understand tobacco has a role in aetiology of oral cancer I am confident in providing tobacco users with written information and self-help material to assist their quitting I believe Nicotine Replacement Therapy is helpful for patient to quit tobacco use I am knowledgeable enough to introduce Nicotine Replacement Therapy for my patients (e.g. the correct dosage, the products available, the possible side effects) I know the mechanism of action of Nicotine Replacement Therapy I am well-prepared to help patients in tobacco cessation I know what is tobacco cessation protocol 2. History taking habit of students for tobacco-using patients Yes No I take tobacco usage histories from all patients I ask patients about their tobacco usage status at the first appointment I update patient's smoking history regularly throughout the whole course of treatment for every patient I always document patient's tobacco use history in patient folder I have patients who are tobacco users I mark down patient as a "non-tobacco user" in patient folder for non-tobacco-using patients 3. For those who have tobacco-using patient(s), I only mark down patient as a "tobacco user" in patient folder for tobacco-using patients I have recorded the amount of tobacco my patients used over the years (e.g. pack year)in patient folder I have recorded the type of tobacco in patient folder (e.g. cigarettes, cigars, e-cigarettes, etc) I have made effort to assist a patient to quit tobacco use I do active tobacco cessation counselling regularly throughout the whole course of treatment for every patient I have succeeded in helping a patient to reduce tobacco consumption I have succeeded in helping a patient to quit tobacco use completely 4. For those who do NOT have patient who is tobacco user If I have a tobacco-using patient, I will only mark down patient as a "tobacco user" in patient folder If I have a tobacco-using patient, I will record the amount of tobacco my patients used over the years (e.g. pack year) in patient folder If I have a tobacco-using patient I will record the types of tobacco in patient folder (e.g. cigarettes, cigars, ecigarettes, etc.) 5. I believe dentists should do the following for tobacco-using patients: Yes No No tobacco cessation counselling is needed Giving tobacco cessation advice verbally Distributing leaflets or pamphlets Giving out the hotline for Tobacco Control Office Writing a referral letter to Tobacco Control Office Prescribe Nicotine Replacement Therapy 6. Before a dentist commences the following treatments for tobacco-using patients (please tick if appropriate): Agree Neutral Disagree Strongly disagree I do not have sufficient skills to provide smoking cessation counselling at this stage of my training I cannot accurately determine patient's' smoking history without being intrusive I do not consider tobacco cessation counselling part of the dentist's professional role Giving smoking cessation counselling is not part of my role as a dental student Patients do not expect tobacco cessation counselling from a dental student Patients do not listen to dental students during tobacco cessation counselling I am concerned that the tobacco cessation usage message may alienate tobacco-using patients Giving unwanted tobacco cessation counselling may upset the dentist-patient relationship Many tobacco-using patients do not have the motivation to quit Tobacco cessation counselling is ineffective unless the patient has a related health problem Clinical time is limited so I tend to focus on dental treatments instead of counselling There is no tobacco cessation information (eg. Leaflets or pamphlets) available in the hospital which I can distribute to my patient There is no referral pathway for tobacco-using patients Thank you for your participation in our research!