Factors Influencing Smoking Cessation Counselling: A Qualitative Study of Medical Residents

Abstract

Introduction: Physicians in training must be able to counsel their patients on smoking cessation, however, little is known about the barriers that they face to counselling their patients.Aims: The study sought to identify barriers to smoking cessation counselling specific to physicians in training.Methods: Qualitative interviews in the form of focus groups were conducted with 30 medical residents. Focus groups were audio taped, transcribed verbatim and coded by two independent reviewers. Similar codes were grouped to form categories and then aggregated to form themes.Results: Seven themes emerged describing resident barriers to provision of smoking cessation counselling : (1) Lack of self-efficacy for providing counselling; (2) their perception that patients are not willing to change; (3) a lack of available resources/information for providers and patients; (4) differences in supervising physician's recommendations; (5) perceived lack of time; (6) a perception of lack of continuous care; and (7) a lack of practical skills in counselling.Conclusions: This study highlighted residents’ perceived barriers to providing smoking cessation counselling. These barriers are similar to those encountered by other providers. Additional barriers specific to residency exist and more training is necessary.Practice Implications: The barriers that physicians encounter to smoking cessation counselling must be addressed early on in residency training.

Lessons from Practice

“…Physicians (N=4) have the ability to prescribe medications, but consistent with prior work [15,39], they are constrained for time. Physicians direct clients to nurses or support staff with tobacco cessation training and/or quitline who are able to dedicate time and are skilled in counseling on quitting smoking.…”

“…Strategies have been recommended for in-person smoking cessation counseling to tailor to specific needs of individuals [43,59]. However, primary care physicians and residents are known to face common barriers such as lack of training, time, and resources to support smoking cessation and conflicts in priorities while managing other health conditions [15,39]. Physicians are thus recommended to redirect clients to dedicated tobacco cessation counsellors and/or telephone based quitline counselors for specialized counseling on quitting smoking [39].…”