Background <p>There has been limited research among family physicians (FPs) in Türkiye regarding smoking cessation and few studies have examined their perceptions of e-cigarettes as smoking cessation aids. This study aimed to examine the knowledge, attitudes and beliefs of FPs in Istanbul about e-cigarettes and their potential role in smoking cessation.</p> Methods <p>A cross-sectional online survey was distributed via email to a convenience sample of FPs in Istanbul. Participants were recruited from a list of family practice clinics provided by the Istanbul Provincial Health Directorate and other social media platforms. Data was collected from August until October 2022. Survey items were drawn from published literature and informed by the Theory of Planned Behaviour. Items were translated to Turkish and assessed knowledge, attitudes, beliefs, and willingness to recommend e-cigarettes as a smoking cessation aid to patients who had failed to quit using other methods.</p> Results <p>We received 243 responses from male (<i>n</i> = 116, 47.7%) and female (<i>n</i> = 127, 52.3%) FPs with an average age of 42 ± 10 years and an average of 9 ± 6 years clinical experience. Most participants believed it was their responsibility to aid patients in getting the correct help to quit smoking (<i>n</i> = 159/217, 73.3%) and that current medications are effective in helping patients quit smoking (<i>n</i> = 171/217, 78.8%). Most disagreed that e-cigarettes were suitable as smoking cessation aids (<i>n</i> = 169/217, 77.9%) or safer than regular cigarettes (<i>n</i> = 165/214, 77.1%). Respondents were concerned e-cigarettes were a gateway to smoking (<i>n</i> = 153/217, 70.5%), addictive (<i>n</i> = 166/217, 76.5%) and harmful to the health of the user (<i>n</i> = 162/215, 75.3%). Over half stated they were not confident in their level of knowledge about e-cigarettes (<i>n</i> = 126/200, 63%), or their ability to answer patient questions (<i>n</i> = 119/200, 59.5%) and talk to patients about e-cigarettes (<i>n</i> = 121/199, 60.8%). More than half stated they would not recommend e-cigarettes to patients that refuse to take alternative treatments (<i>n</i> = 121/197, 61.4%) or to patients that have failed to quit using other methods (<i>n</i> = 118/197, 59.9%).</p> Conclusion <p>Family physicians in Istanbul demonstrated poor knowledge and confidence regarding e-cigarettes and generally held negative attitudes toward their use for smoking cessation. Knowledge and beliefs about effectiveness of e-cigarettes were key factors associated with recommendation practices. These findings highlight the need for education and guidance to support FPs in responding to patient enquiries about e-cigarettes, in line with the current regulatory context in Türkiye.</p>