A review of the evidence based smoking cessation interventions delivered by the family physician

Smoking is one of the most preventable causes of morbidity and mortality resulting in almost 10,000 deaths each year in Israel. Since tobacco-related disease is preventable, efforts to promote cessation in patients who smoke should be a routine step in preventive primary care measures. In Israel, 26% of the adult population smoke. Within this group, a third want to quit but only two percent succeed in abstaining from smoking for a whole year. Family physicians are in an ideal position to facilitate patients' attempts to quit smoking: 70% of smoking patients report that firm, supportive messages from their family physician can act as an important motivating factor to quit smoking. The updated Clinical Practice Guidelines from the US Public Health Service recommend that family physicians should opportunistically advise smokers to stop smoking during routine consultation, encourage and assist smokers in the use of nicotine replacement therapies or bupropion and refer smokers to professional behavioral or psychological counselors specializing in smoking cessation. Most physicians rank smoking as the most important behavior affecting health, but few physicians are confident in their own ability to help their patients stop smoking. In this review the authors present several evidence-based strategies that were found to be helpful in promoting smoking cessation when delivered by general practitioners. The power of the physician's advice, first and second line agents, behavioral counseling and stage based interventions, are all discussed in detail.