Physician-delivered smoking cessation advice: issues identified during ethnographic interviews

Abstract

Objective-To identify the factors that physicians believe impair their ability to provide smoking cessation advice to their patients. Design - Ethnographic interviews of physicians. Setting - Non-academic primary care practice. Subjects -18 of 27 physicians who had recently participated in the intervention group of a randomised clinical trial to increase the rate at which physicians give smoking cessation advice. Main outcome measures -Factors that the interviewees reported were affecting their ability to give smoking cessation advice. Results -The interviews generated 439 statements that we sorted into 19 cate gories. We judged 10 of the categories to be statements about medical practice and smoking in general, and nine of the categories to represent barriers to giving smoking cessation advice. The barriers described by the interviewees included: lack of patient interest, lack of physician perceived self-efficacy, lack of time, lack of organisational support, lack of reward to the physician, lack of peer support, lack of staff support, and lack of interest on the part of the physician. The com mercial promotion of tobacco was also identified as a barrier to giving smoking cessation advice. Conclusions - As reported by physicians who had participated in a trial to provide smoking cessation advice in their own practices, the barriers to giving smoking cessation advice are more than a lack of knowledge that smoking is a health hazard and the lack of skills to help the patient stop smoking. These additional barriers may need to be addressed if physicians are to improve the rates at which they identify their patients who smoke and assist them in quitting.