Smoking cessation counselling in general practice for COPD smokers: determinants for general practitioners' compliance with a treatment protocol

Abstract

For chronic obstructive pulmonary disease (COPD), smoking cessation is the main treatment goal. We examined compliance with a smoking cessation treatment protocol for COPD smokers by 47 general practitioners (GPs). Baseline and evaluation questionnaires were completed, and 34 of the GPs then took part in a semi-structured telephone interview. The main outcome measure was restarting of the protocol when a patient had relapsed during a quit attempt. Attitudes, social influences and perceived self-efficacy were assessed to understand compliance or non-compliance with the treatment protocol. The rates of self-reported compliance with seven out of nine aspects of the protocol were high (76% on average). Fifty-three per cent of the GPs restarted the treatment protocol following patient's relapse. A substantial percentage of the GPs reported being seriously disappointed by the effectiveness of the treatment protocol. A change of practice personnel or having unmotivated personnel hindered compliance with the treatment protocol. The majority of the GPs planned to continue using the protocol. Given that negative attitudes, a perceived lack of social support and lack of counselling self-confidence were associated with lower protocol compliance, less confident GPs and GPs who have negative attitudes towards the provision of smoking cessation support should delegate the counselling or refer their patients. It is also concluded that GPs should be given more realistic expectations about smoking cessation and, rather than drop support efforts when they experience a lack of time or lack of confidence for counselling smoking cessation, delegate these tasks to practice assistants or other personnel.