title: Factors influencing European GPs' engagement in smoking cessation: a multi-country literature review.
abstract: BACKGROUND
  Smoking cessation advice by GPs is an effective and cost-effective intervention, but is not implemented as widely as it could be.
  
  
  OBJECTIVE
  This wide-ranging Europe-wide literature review, part of the European Union (EU) PESCE (General Practitioners and the Economics of Smoking Cessation in Europe) project, explored the extent of GPs' engagement in smoking cessation and the factors that influence their engagement.
  
  
  METHODS
  Two searches were conducted, one for grey literature, across all European countries, and one for academic studies. Data from eligible studies published from 1990 onwards were synthesised and reported under four categories of influencing factors: GP characteristics, patient characteristics, structural factors, and cessation-specific knowledge and skills.
  
  
  RESULTS
  The literature showed that most GPs in Europe question the smoking status of all new patients but fewer routinely ask this of regular patients, or advise smokers to quit. The proportion offering intensive interventions or prescribing treatments is lower still. Factors influencing GPs' engagement in smoking cessation include GPs' own smoking status and their attitudes towards giving smoking cessation advice; whether patients present with smoking-related symptoms, are pregnant, or heavy smokers; time, training, and reimbursement are important structural factors; and some GPs lack knowledge and skills regarding the use of specific cessation methods and treatments, or have limited awareness of specialist cessation services. No single factor or category of factors explains the variations in GPs' engagement in smoking cessation.
  
  
  CONCLUSIONS
  Strategies to improve the frequency and quality of GPs' engagement in smoking cessation need to address the multifaceted influences on GPs' practice and to reflect the widely differing contexts across Europe.
authors.affiliation: Institute for Social Marketing, University of Stirling and The Open University, Stirling FK94LA. martine.stead@stir.ac.uk
authors.forename: Martine
authors.initials: M
authors.lastname: Stead
authors.forename: Kathryn
authors.initials: K
authors.lastname: Angus
authors.forename: Ingrid
authors.initials: I
authors.lastname: Holme
authors.forename: David
authors.initials: D
authors.lastname: Cohen
authors.forename: Gayle
authors.initials: G
authors.lastname: Tait
mesh_terms: D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D005060:Europe; D005194:Family Practice / Q000191:economics; D006293:Health Promotion / Q000191:economics / Q000379:methods*; D006801:Humans; D010817:Physician-Patient Relations; D011364:Professional Practice / Q000191:economics; D016540:Smoking Cessation / Q000191:economics / Q000379:methods*
references.citation: Patient Educ Couns. 2006 Oct;63(1-2):232-8
references.pmid: 16531000
references.citation: Soz Praventivmed. 2005;50(6):355-60
references.pmid: 16398097
references.citation: Prev Med. 2005 May;40(5):595-601
references.pmid: 15749144
references.citation: Tob Control. 2004 Mar;13(1):74-7
references.pmid: 14985601
references.citation: Scand J Public Health. 2002;30(2):141-7
references.pmid: 12028863
references.citation: Tob Control. 1998 Autumn;7(3):241-6
references.pmid: 9825418
references.citation: Epidemiol Prev. 2006 Nov-Dec;30(6):343-7
references.pmid: 17333689
references.citation: BMJ. 2001 Aug 25;323(7310):435-6
references.pmid: 11520845
references.citation: Acta Clin Belg. 2000 Sep-Oct;55(5):266-75
references.pmid: 11109641
references.citation: Ir Med J. 2004 Oct;97(9):270-3
references.pmid: 15568584
references.citation: BMC Fam Pract. 2001;2:6
references.pmid: 11701091
references.citation: Int J Clin Pract. 2004 Feb;58(2):130-8
references.pmid: 15055860
references.citation: Lakartidningen. 2002 Jul 25;99(30-31):3111-7
references.pmid: 12198930
references.citation: Wien Klin Wochenschr. 2002 Sep 30;114(17-18):762-5
references.pmid: 12416280
references.citation: Addiction. 1999 Jan;94(1):125-32
references.pmid: 10665104
references.citation: Public Health. 2005 Apr;119(4):262-8
references.pmid: 15733685
references.citation: Addiction. 2004 Dec;99(12):1586-98
references.pmid: 15585050
references.citation: Int J Clin Pract. 2005 Apr;59(4):447-52
references.pmid: 15853863
references.citation: Fam Pract. 2004 Oct;21(5):587-93
references.pmid: 15367483
references.citation: Fam Pract. 2001 Feb;18(1):14-20
references.pmid: 11145622
references.citation: Addiction. 2007 May;102(5):803-8
references.pmid: 17506157
references.citation: Eur J Public Health. 2004 Jun;14(2):199-200
references.pmid: 15230510
references.citation: Tob Control. 2001 Mar;10(1):27-32
references.pmid: 11226357
references.citation: J Fam Pract. 2000 May;49(5):461-4
references.pmid: 10836780
references.citation: Fam Pract. 1994 Jun;11(2):111-6
references.pmid: 7958571
references.citation: Health Promot Int. 2005 Mar;20(1):41-9
references.pmid: 15681593
references.citation: Tob Control. 2000;9 Suppl 1:I37-41
references.pmid: 10688930
references.citation: Nicotine Tob Res. 2003 Apr;5(2):163-8
references.pmid: 12745488
references.citation: Addiction. 2008 May;103(5):824-31
references.pmid: 18412761
references.citation: Addiction. 2004 Nov;99(11):1470-4
references.pmid: 15500600
references.citation: Public Health. 2007 May;121(5):333-40
references.pmid: 17223144
references.citation: Soz Praventivmed. 1996;41(4):224-30
references.pmid: 8806158
references.citation: Am J Prev Med. 1992 Nov-Dec;8(6):333-8
references.pmid: 1482572
references.citation: Br J Gen Pract. 2000 Dec;50(461):1001-4
references.pmid: 11224956
references.citation: Qual Saf Health Care. 2006 Aug;15(4):284-8
references.pmid: 16885254
references.citation: Public Health. 2005 May;119(5):390-9
references.pmid: 15780327
references.citation: Nicotine Tob Res. 2006 Dec;8(6):785-90
references.pmid: 17132526
references.citation: Tumori. 2003 May-Jun;89(3):250-4
references.pmid: 12908777
references.citation: Tob Control. 2002 Mar;11(1):44-6
references.pmid: 11891367
references.citation: Nicotine Tob Res. 2005 Aug;7(4):541-6
references.pmid: 16085525
references.citation: Br J Gen Pract. 2000 Mar;50(452):207-10
references.pmid: 10750230
references.citation: Eur J Public Health. 2005 Apr;15(2):140-5
references.pmid: 15941758
references.citation: Br J Gen Pract. 2002 Dec;52(485):997-9
references.pmid: 12528585
references.citation: Br J Gen Pract. 1996 Feb;46(403):87-91
references.pmid: 8855014
references.citation: Soc Sci Med. 1993 Mar;36(6):817-22
references.pmid: 8480226
references.citation: Fam Pract. 2003 Jun;20(3):254-61
references.pmid: 12738693
references.citation: Patient Educ Couns. 2006 Jul;62(1):89-94
references.pmid: 16023821
references.citation: Tidsskr Nor Laegeforen. 2002 Nov 10;122(27):2608-11
references.pmid: 12523189
references.citation: J Fam Pract. 2002 Nov;51(11):938-42
references.pmid: 12485547
references.citation: BMJ. 2001 Aug 25;323(7310):432-5
references.pmid: 11520844