General practitioners' perceived barriers to smoking cessation - results from four Nordic countries

Aims: Studies indicate that doctors may be reluctant to discuss smoking with their patients. Knowledge about how this problem might be solved is limited. The aim of this study was to identify barriers for engaging in tobacco prevention in general practice. Methods: An anonymous questionnaire was mailed to 3,167 randomly selected general practitioners (GPs) in Sweden Norway, Finland, and Iceland. The questionnaire identified practice and barriers for the discussion of smoking and smoking cessation with patients and the GPs own smoking behaviour. Results: The overall response rate was 67%. A large majority of the GPs perceived the discussion of patients' smoking habits as part of their job. However, most GPs did not enquire about smoking unless the patient had smoking-related symptoms and few engaged in smoking cessation support. Many GPs felt that smoking cessation support was too time consuming and that the time spent was not effective because few patients quit. Shortage of smoking cessation experts to whom patients could be referred was the most common barrier for systematic involvement in smoking cessation support. On average, GPs had spent approximately one hour during the previous month on smoking cessation support. Conclusion: The main barriers identified in this study indicate that smoking cessation expertise needs to be more accessible. One alternative is to establish telephone help-lines (Quit-lines) that are easily available for all and could serve as a back-up for the GPs. Another more costly approach is to develop smoking cessation expertise at major clinics. A combination of both is probably the best solution.