Physician Views and Attitudes Regarding Tobacco-Cessation Strategies for Patients with Rheumatoid Arthritis.

Objective: In this study, we explored physicians' level of experience with patients with rheumatoid arthritis (RA) who used tobacco; their views on the effects of tobacco use on the efficacy of RA treatments; and their experiences and attitudes with respect to tobacco cessation programs.

Methods: We conducted qualitative, semi-structured interviews of 20 physicians (10 primary-care physicians [PCPs] and 10 rheumatologists).

Results: The physicians had been in clinical practice for a mean of 9.9 years. Research themes included 1) risk perception of smoking, 2) cessation aids used, 3) preferences to deliver cessation programs, and 4) barriers and facilitators for tobacco cessation. For the first theme, many PCPs did not perceive smoking as influencing RA disease activity. For the second theme, most physicians supported the use of nicotine-replacement therapy and agreed that cessation-drug therapy (e.g., varenicline, bupropion) worked better than nicotine-replacement therapy or other cessation strategies, especially in patients with failed cessation attempts. For the third theme, some physicians recommended that patients join the Quitline cessation program and enroll in peer-support communities; others found educational programs informing patients about benefits of quitting and tailored with messages according to patients' specific clinical characteristics to be useful. For the fourth theme, PCPs and rheumatologists reported similar barriers to offering smoking cessation programs (e.g., lack of time, training in tobacco cessation, and financial motivation).

Conclusions: Physicians agreed with the need for tailored, multifaceted interventions to support tobacco cessation in patients with RA. However, many perceived major barriers to helping their patients quit, some of which could be overcome by training.