Factors impeding psychiatrists from promoting smoking cessation among people with serious mental illness–A mixed methods study

Psychiatrists' beliefs and behaviors regarding smoking cessation promotion among people with serious mental illness (PWSMI) have been cited as a barrier for PWSMI achieving successful abstinence. A mixed methods approach was employed to evaluate beliefs and practices of psychiatrists affiliated with a large HMO in Israel regarding smoking cessation among PWSMI. Fifty psychiatrists (43% response rate) completed a telephone survey and thirty psychiatrists interviewed using a semi-structured questionnaire. Most of the psychiatrists (84%) saw smoking cessation promotion as part of their role, but in-depth interviews revealed that only a third were routinely pro-active, with over half believing that few PWSMI are willing or capable of quitting smoking. Most of the study population felt that an attempt to quit smoking would not adversely affect their patients' mental health status, but many raised concerns regarding the safety of smoking cessation medications (SCM) amongst PWSMI. Factors associated with pro-active practice were knowledge regarding services and SCM, characteristics of patient caseload (proportion low-functioning) and psychiatrist’s smoking behavior. Psychiatrist-targeted interventions highlighting safety of SCM and promoting referral to smoking cessation services are indicated. Offering PWSMI-specific harm reduction as a first step to abstinence may offer psychiatrists an acceptable treatment alternative for the low-functioning patient.