Smoking cessation counseling: What do physicians really say and how do they say it?
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The U.S. Public Health Service Clinical Practice Guideline recommends that physicians provide tobacco cessation interventions to their patients at every visit. While many studies have examined the extent to which physicians implement the guideline's "5 A's" (for smokers ready to quit) few studies have examined the extent to which physicians implement the guideline's"5 R's" (risks, rewards, relevance, roadblocks, and repeat) which are to be used in a Motivational Interviewing (MI) consistent style with smokers not ready to quit. The purpose of this study was to examine to what extent physicians in usual practice and without specific training administered the 5 R's including the use of an MI style. Participants included thirty-eight physicians who were audio recorded by a research assistant during their routine clinical practice conversations with patients who smoked. The audio files were transcribed and coded by independent raters on the implementation of each of the 5 A's and 5 R's and counseling style using the Motivational Interviewing Skill Code. Results revealed that physicians frequently asked (94%) and assessed (87%) patients about their smoking status. For patients who were ready to quit, physicians frequently advised (74%) patients to quit, but less frequently offered assistance to quit (68%) and arranged a follow-up appointment with patients (23%). During counseling sessions with patients who were not ready to quit smoking, physicians most frequently discussed the patient's personal relevance for quitting (82%), followed by discussing the risks of smoking (73%). roadblocks (45%) and rewards (36%) were discussed relatively infrequently. MI skill code analyses revealed that physicians, on average, had a moderate score for acceptance (4.5 on a 1-7 point scale) and autonomy support (4.0), a low to moderate score for collaboration (3.3) and low scores for empathy (3.0) and evocation (2.7). Specific behavior counts revealed that the most frequent behavior was to give information. Overall, physicians engaged in more MI inconsistent strategies rather than MI consistent strategies. Results suggest that for the Clinical Guideline to be implemented appropriately physicians will need specialized training or will need to be able to refer patients to counselors with the necessary expertise.
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Introduction and background -- Methodology -- Results -- Discussion
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M.A.