Qualitative study investigating the process of giving anti-smoking advice in general practice

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Abstract

General practitioners’ (GPs’) anti-smoking advice promotes patients’ smoking cessation but little is known about how GPs use their short consultations to give advice. We used semi-structured interviews with 27 UK GPs to investigate how GPs believe they should advise smokers to stop and the reasons underpinning these beliefs. GPs reported a limited repertoire of techniques for dealing with smokers who were not motivated to stop. They also reported using confrontational advice-giving styles with patients who continued to smoke despite suffering from smoking-related illnesses. GPs might find it easier and more rewarding to discuss smoking with patients if they possessed a greater range of skills for dealing with non-motivated smokers.

Introduction

Smoking remains a public health problem [1], [2], but general practitioners’ advice can encourage smokers to stop [3]. For every 50 smokers who are advised to quit by their general practitioner, one or two will become a non-smoker [3]. Despite the acknowledged efficacy of general practitioners’ advice, they advise few smokers [4] and try to avoid confrontation with patients by restricting much of their advice to patients with smoking-related problems [5]. Nevertheless, doctors’ advice is not always well-received by smokers and is resented by some [6]. A previous study found that where general practitioners anticipated negative reactions to their advice or perceived the doctor:patient relationship was poor, they were less likely to discuss smoking with patients [5]. General practitioners chose patients with whom they discussed smoking carefully. In this paper we report an analysis of general practitioners’ accounts of their advice-giving, to determine how factors described above, or other factors, influence the process of discussing smoking in routine consultations. We aim to provide insight into the influences on this aspect of general practitioners’ clinical behaviour and raise hypotheses about how the process of advice-giving might be improved. This is particularly relevant in the UK today as the new smoking cessation services implemented by the UK government have a brief to train health professionals in smoking cessation methods [7] and effective training courses for general practitioners need to be informed by knowledge of current clinical practice.

Section snippets

Methods

Data presented in this paper were collected during interviews with GPs conducted for another study and study methods have been described elsewhere [4], [8], [9], [10], [11], but a summary of these follows. Findings presented in this paper resulted from a further (secondary) analysis of these interviews and have not been published before in any form elsewhere.

Results

Of the 42 general practitioners who allowed their surgery sessions to be video-recorded, two had no smokers attend their surgeries and one declined to be interviewed, so 39 interviews were conducted in total. No discussion of smoking occurred in 12 general practitioners’ video-recorded consultations, so interviews with these general practitioners did not contribute to the analysis presented below. Data presented below are, therefore, from the 27 interviews conducted after general practitioners

Discussion and conclusions

When raising the issue of smoking with patients, general practitioners respond carefully to smokers’ reactions. Most GPs are more comfortable using non-confrontational approaches towards discussing smoking which are most easily applied where smokers have already decided that they wish to stop smoking. General practitioners report a limited repertoire of consulting skills for dealing with smokers whom they believe are not motivated to try stopping smoking and tend to avoid detailed discussion

Acknowledgements

We wish to thank Mrs. Margaret Whatley and Miss Laura Jones for secretarial expertise. This research was funded by the Scientific Foundation Board of the Royal College of General Practitioners and Trent NHS Executive.

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