Smoking-cessation strategies observed in videotaped general practice consultations

Background: This study describes opportunistic smoking-cessation counseling and compares strategies used in general practice to experts' recommendations. Methods: In this observational study we analysed 157 videotaped consultations with self-reported smokers, visiting 70 Australian general practitioners (GPs) who were randomly enrolled in the Victorian General Practice Study. Smoking-cessation strategies were analysed using a rating form assessed for intrarater reliability and compared to recommendations of 20 experts surveyed to ascertain effective and feasible strategies. Results: GPs identified smokers in 32% of consultations and counselled them in 29%. Median counselling time was 44 seconds in encounters typically lasting 10 minutes. When smoking was raised, advice to quit, personalising risks, discussing health risks, and quantifying consumption were the most commonly used strategies (46%-54%). Assessment of motivation to quit, individualised education, practical hints to stop, written materials, and followup were observed in a third or less of interventions. Quit dates and nicotine replacement were never proposed. Conclusions: GPs miss many opportunities to advise smokers to quit and rarely use effective smoking-cessation techniques as recommended. Medical education has failed to provide GPs with skills to counsel smokers routinely and effectively. We recommend better training of GPs in effective smoking-cessation strategies and incentives to facilitate their implementation in practice.