Physician attitudes and the use of office-based activities for tobacco control.

OBJECTIVES: This study explored family physicians' attitudes about smoking cessation counseling-its importance, their confidence in their ability to counsel, outcome expectations of counseling, perception of their influence on patient behavior types of counseling skills used, and the extent to which office-based activities are used to support their counseling.
METHODS: A cross-sectional design using qualitative and quantitative analyses was used. Data, including information from participant observation of the environment, medical chart reviews, and in-depth interviews, were collected from 89 physicians, drawn randomly from a list of family physicians in Nebraska.
RESULTS: All physicians felt that counseling was important, and most were confident with their ability to provide cessation counseling. Only one third of physicians had positive expectations regarding the outcome of this counseling or of their influence on patient behavior in general. The counseling skills most likely to be used were giving advice to quit, prescriptions for pharmaceutical aids, and discussing barriers and resources. Office-based strategies to support physician counseling were seldom used.
CONCLUSIONS: Physician attitudes and tobacco-control activities present a complex picture of low expectations, little office support, and limited counseling skills combined with a strong belief in the professional responsibility to counsel. Motivation to increase skills or implement supportive systems could be expected to be low.