BACKGROUND-AIM:
The majority of smokers want to quit smoking, but most of them try to do it without cessation help. Although support for smoking cessation provided by general practitioners (GP) has proven effective, such an approach remains quite rare. Based on a literature review about barriers to smoking cessation in patients and to the provision of support by GPs, we designed a behavioural science-based intervention to increase discussions on this topic in general practice consultation. The present study aimed to evaluate the effectiveness of this in-office paper-based intervention by comparing it with a no-intervention control group.

METHODS:
We conducted an online randomised controlled trial between January and May 2024 among GPs in France. The intervention consisted in sending a kit containing an information sheet for GPs outlining the main stages of a brief advice activity for smoking cessation, questionnaires for patients asking them about their smoking status and, for those who smoked, their previous quit attempts and motivation to quit, as well as a poster to be displayed in each GP’s waiting room to encourage smokers to complete the questionnaire. GPs included in the control group received no intervention. The primary outcome was the proportion of smokers with whom GPs had discussed smoking cessation on their last full working day five weeks after the kit had been sent out. The secondary outcome was the probability that GPs provided cessation support (e.g., proposed nicotine replacement therapy (NRT), a follow-up consultation, and/or referred patients to other professionals) on the same day. Exploratory variables included several activities mentioned in the information sheet for GPs.

RESULTS:
Of the 800 GPs recruited, 641 fully completed the final survey (333 in the intervention group and 308 in the control group). The proportion of smokers with whom GPs had discussed cessation was significantly higher in the intervention group (59.0% vs 52.3%, p<0.05). The likelihood of a follow-up consultation being offered was also significantly higher in the intervention group (73.8% vs 60.3%, p<0.05). NRT proposal and referral were not significantly different between groups (82.4% vs. 77.9%, and 23.3% vs. 21.5%, respectively). The proportion of GPs who evaluated tobacco dependence for at least half of their patients who smoked was significantly higher in the intervention group (33.4% vs 24.3%, p < 0.05). Moreover, the proportion of GPs who assessed patients’ motivations to quit was notably, albeit not significantly, higher in the intervention group (51.3% vs 43.2%, p=0.056).

CONCLUSIONS:
Providing simple paper-based tools was associated with a greater likelihood of GPs discussing smoking cessation with their patients. Effects were also observed on support for smoking cessation. This kind of intervention could usefully complement more demanding ones, including training for health professionals, with a view to significantly increasing smoking cessation.