Qualitative study of patients' perceptions of doctors' advice to quit smoking: implications for opportunistic health promotion

BMJ 1998;316:1878-1881 ( 20 June )

General Practice

Qualitative study of patients' perceptions of doctors' advice to quit smoking: implications for opportunistic health promotion

Christopher C Butler, lecturer, Roisin Pill, professor, Nigel C H Stott, professor.

Department of General Practice, University of Wales College of Medicine, Cardiff CF3 7PN

Correspondence to: Dr Butler butlercc{at}cf.ac.uk

Objectives: To determine the effectiveness and acceptability of general practitioners'opportunistic antismoking interventionsby examining detailed accounts of smokers' experiences of these.
Design: Qualitative semistructured interview study.
Setting: South Wales.
Subjects: 42 participants in the Welsh smoking intervention study were asked about initial smoking, attempts to quit, thoughts about future smoking, past experiences with the health services, and the most appropriate way for health services tohelp them and other smokers.
Results: Main emerging themes were that subjects already made their own evaluations about smoking, did not believe doctors' words could influence their smoking, believed that quitting was down to the individual, and felt that doctors who took the opportunity to talk about smoking should focus on the individual patient. Smokers anticipated that they would be given antismoking advice by doctors when attending for health care; they reactedby shrugging this off, feeling guilty, or becoming annoyed. These reactions affected the help seeking behaviour of some respondents. Smokers were categorised as "contrary," "matter of fact," and "self blaming," depending on their reported reaction to antismoking advice.
Conclusions: Doctor-patient relationships can be damaged if doctors routinely advise all smokers to quit. Where doctors intervene, a patient centred approach $---$ one that considers how individualpatients view themselves as smokers and how they are likely toreact to different styles of intervention $---$ is the most acceptable.

Key messages

Many patients who smoke are sceptical about the power of doctors' words to influence smoking since most know about the dangers, make their own evaluations, and feel that quitting is down to the individual
Opportunistic antismoking interventions should be sympathetic, not preaching, and centred on the patient as an individual
Repeated ritualistic intervention on the part of doctors may deter patients from seeking medical help when they need it
Smokers can be categorised as "contrary," "matter of fact," or "self blaming" in their reaction to antismoking advice
Doctors can tailor their approach according to the type of patient

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