Family Physician Education and Barriers to Promoting Smoking Cessation: A Multiservice Investigation.

Abstract

Cigarette smoking remains the leading cause of preventable disease and death in the United States. Brief discussions with doctors increase cessation rates by two-thirds, and physicians trained in smoking cessation are more likely to perform counseling. Multiple organizations also recommend connecting counseling with lung cancer screening (LCS), yet physicians and patients report a lack of such integration. We sought to characterize the education received and the barriers to providing smoking cessation counseling, and to determine its integration with LCS among military Family Medicine physicians. This is a cross-sectional study of registered attendees of 2022 Uniformed Services Academy of Family Physicians Annual Conference. Our study aimed to: (1) Assess the amount of formal smoking cessation education during and after residency; (2) assess barriers to providing smoking cessation within the military health care system; and (3) assess if physicians connect smoking cessation counseling and LCS. Descriptive statistics with chi-squared analysis were used to analyze the survey results. With a response rate of 61% (n = 323/487), most participants reported receiving <3 sessions of formal education during residency (72.9%) and <3 h after residency (76.2%). Forty-eight percent cited their health care system never or rarely provided resources on smoking cessation. Time was the largest barrier to promoting smoking cessation (62.6%) and to integrating it with LCS (56.7%), although a considerable percentage also cited lack of supporting staff (34.3%). Furthermore, only 50.6% of respondents always reported counseling on smoking cessation with LCS. Smoking cessation education is provided in family medicine residencies but rarely offered afterwards. Time and lack of support staff and resources are recognized as notable barriers within the military health care system. A large proportion of uniformed Family Medicine physicians also do not link LCS guidelines with patient education on tobacco cessation and resources. Further research is needed to guide interventions to overcome these challenges within the military health care system.