Introduction:
Physicians miss many opportunities to provide smoking cessation counseling despite patient interest and demonstrated efficacy of brief counseling in routine clinical care. The study aimed to reveal what influences primary healthcare physicians’ (PHPs) decision to discuss smoking cessation with patients.

Material and Methods:
The study team implemented a qualitative research through focus group discussions with PHPs using a semi-structured guide. Purposive sampling was used to recruit participants (n=23) from two Armenian cities. Collected data were transcribed and analyzed by directed content analysis technique.

Results:
The majority of PHPs reported that they did not routinely discuss smoking with patients without smoking-related problems, as they were afraid of harming physician-patient relationship. PHPs’ believed that asking patients about their smoking status could be “offensive” and “harmful”. Some of PHPs were considering smoking as a culturally sensitive issue and prefer checking smoking status of men rather than women. The smell of smoke, voice changes, or bronchitis made PHPs to discuss smoking with women. Physicians also tend to miss the opportunity to discuss smoking with special patient subgroups (elderly patients, patients with severe co-morbidities) because of the misbelief that smoking “already harmed” them. Excessive paper work, shortage of time were identified as other obstacles for using the opportunity to discuss smoking.

Conclusions:
Physicians appear to prioritize smoking cessation counseling based on patients’ socio-demographic characteristics (age, gender) and diagnosis at the time of the visit. Specific interventions should be implemented to motivate physicians’ to use opportunities to discuss smoking cessation during routine consultations with all patients.

Funding:
The study was supported by the Global Bridges Healthcare Alliance for Tobacco Dependence Treatment, hosted by Mayo Clinic and Pfizer Independent Grants for Learning and Change.