Smoking cessation in primary care: Exploration of barriers and solutions in current daily practice from the perspective of smokers and healthcare professionals

Background: Evidence based recommendations for smoking cessation are not followed in routine primary care. A better understanding is needed why smoking cessation treatment is still underutilized. Objectives: To explore barriers and solutions of smoking cessation treatment, from the perspective of smokers and healthcare professionals in Dutch primary care. Methods: Focus groups were conducted with 14 smokers (smokers and ex-smokers) and semi-structured individual interviews with nine healthcare professionals (general practitioners and practice nurses). Data was analysed using the Constant Comparative Method. Results: Barriers that prevented successful smoking cessation treatment were the lack of awareness regarding the available smoking cessation treatments at the healthcare centre among smokers and the resistance against preventive tasks among healthcare professionals. Nonetheless, general practitioners (GPs) did not fear jeopardizing the doctor-patient relationship by discussing smoking. Quitting was regarded as the smokers' own responsibility and GPs felt that merely using medication was no guarantee for successful quitting. Even so, practice nurses and smokers preferred medication use. Proposed solutions were that GPs should advise smokers to quit, whereas someone else should deliver intensive behavioural support, preferably the practice nurse. Conclusion: Smokers and healthcare professionals seem to wait for each other to start smoking cessation. GPs should know that they could discuss smoking cessation with every patient without jeopardizing the doctor-patient relationship, preferably followed by referral to a practice nurse for intensive behavioural support. Furthermore, more patients should know that they could receive pharmacological treatment as well as behavioural support for smoking cessation in their healthcare centre.