France: General practitioners still insufficiently trained in smoking cessation

The ACT Alliance Against Tobacco and the BVA survey institute conducted a survey[1] with 500 general practitioners in France to assess their patients' smoking cessation management and their perception of tobacco and nicotine products. More than half of them (53%) would like to receive specific training on smoking cessation.

The survey was conducted online among 500 general practitioners between February and March 2024.

General practitioners, on the front line to support smokers

Although nearly all (99%) general practitioners reported discussing smoking status with their patients, only 38% do so systematically. When they learn that their patient is a smoker, only 58% systematically suggest quitting (35% often and 6% occasionally). Among the obstacles put forward by practitioners to support smoking cessation, lack of time (71 %) is the main reason given. Added to this is the fact that the original reason for the consultation is not the issue of tobacco (56 %) or the fear of appearing intrusive (26 %). The survey also reveals that exposure to passive smoking is only mentioned by 60% of professionals.

General practitioners (GPs) are essential in supporting smokers in their efforts to quit. Support from a healthcare professional increases the chances of successfully quitting and maintaining abstinence by 70%. However, according to the survey, nearly a quarter of them (23%) do not feel they are effective in managing smoking cessation. Thus, 53% of them would like to receive specific training on the issue of smoking cessation.

The issue of smoking cessation remains essential while tobacco consumption stagnates at a very high level in the general population. Thus, 31.8% of French adults aged 18-75 declare themselves smokers, 24.5% smoke daily. While the issue of tobacco is part of the initial training curriculum for general practitioners, this training seems insufficient given the importance of the health problem that smoking represents. This need for training appears even greater for other health professionals authorized to manage smoking cessation but who have not received training. To address this issue, a free training course for health professionals on smoking cessation was launched in the Grand Est last April.[2].

Improvement needed in the prescription of nicotine substitutes

The survey also highlights that the prescription of nicotine replacement therapy, although effective in helping people quit smoking, remains underutilized by general practitioners. Professor Daniel Thomas, vice-president of the ACT and the National Committee Against Smoking (CNCT), is surprised by the persistence of misconceptions about nicotine replacement therapy (NRT) and the reluctance to prescribe high-dose replacement therapy for heavy smokers.

In light of these findings, the ACT proposes implementing mandatory training courses dedicated to nicotine addiction and its management, both as part of the core curriculum for university health programs and as part of continuing education. It also recommends creating a dedicated rating system for smoking cessation support consultations for all healthcare professionals.

The ACT and its members also call for an update of the regulatory framework for marketing authorizations (MAs) for NRTs, which they believe are no longer fully compliant with recommendations. The possibility of prescribing multiple patches to ensure a sufficient dose of nicotine for the most dependent patients and the possibility of combining several NRTs are particularly emphasized.

Doctors misinformed about new tobacco and nicotine products

The vast majority of general practitioners (90%) report being poorly informed about new tobacco and nicotine products. While most consider other tobacco products (heated tobacco and snus) to be as harmful as traditional cigarettes, nearly 40% of them consider nicotine pouches and pearls to be effective cessation tools, even though to date, no independent study confirms the effectiveness of these products in smoking cessation. The World Health Organization (WHO) does not consider these products to be tools to help people quit smoking and calls on countries to regulate them more strictly. New nicotine products, particularly oral products such as pouches and pearls, are promoted as smoking cessation tools by tobacco manufacturers. This is therefore a marketing tool designed in particular to dissuade smokers from completely stopping all nicotine products.

More than 90 % general practitioners say they are ill-informed about how to help their patients wean themselves off these new products, which often contain very high doses of nicotine.

©Generation Without Tobacco

AE

[1] Press release, Smoking cessation: almost half of general practitioners are waiting for specific training, Alliance Against Tobacco, published May 31, 2024

[2] Tobacco-free generation, Grand Est: launch of free training on smoking cessation for health professionals, published April 19, 2024, accessed June 5, 2024