Combining Default Choices and a Decision Aid to Improve Tobacco Cessation

Smoking cessation medications are underused in primary care, likely because general practitioners (GP) lack detailed knowledge about prescribing and the fact that smokers seen in primary care must "opt-in" to treatment. Currently GPs only offer treatment to patients who say they are ready to quit smoking and desire treatment, making the default choice no treatment. Those who are not ready to quit or are hesitant do not discuss quitting or learn about options to help them quit. Further, GPs often lack confidence to discuss smoking cessation medications or do not provide patients with a choice. A decision aid can both help to present quitting with a medication as the default choice and promote shared decision making by allowing patients to see the menu of options available.

The current study will combine the use of 'default choices' when approaching smokers and shared decision making with a decision aid for choosing between smoking cessation treatments. The investigators will train GPs to offer smoking cessation as the default choice while involving patients in key decisions using a decision aid. This innovative approach has not been tested in primary care and has the potential to increase the number of current smokers who make a quit attempt with a proven quit aid, thereby increasing the number of patients who quit smoking.

The investigators will implement the training as part of the Vivre sans tabac programme for GPs run by the Swiss Medical Association (FMH).

Patient-level inclusion criteria:

• Consider the GP they are seeing in consultation to be their primary care doctor
• Use tobacco daily (cigarettes, cigars, smokeless tobacco)
• ≥18 years of age at the time of inclusion

Patient-level exclusion criteria:

• Consulting for an urgent complaint that precludes even a brief discussion of smoking cessation
• Inability to follow the procedures of the study, e.g. unable to read French-language consent materials, severe psychiatric disorders, dementia, etc.
• Previous enrolment in a smoking cessation trial <1 year prior
• Current daily user of a pharmacologic smoking cessation aid

GP-level inclusion criteria:

• GP in private practice in French-speaking Switzerland (Vaud, Geneva, Jura, Neuchâtel, Fribourg or Valais) or metropolitan France
• Primarily French-speaking patients with >80 individual patients seen in a typical month

GP-level exclusion criteria:

• Completed an intensive smoking cessation curriculum <2 years prior (ie. at least half-day of training)
• Have plans to retire or relocate outside of Switzerland or France in <12 months