Keeping morality out and the GP in

When primary care providers and smokers meet: a systematic review and metasynthesis

“…Some patients expected nothing from their PCPs, that is, they did not want any advice or even the subject to be raised in consultations 39 , 41 , 46 . They argued that their tobacco use problem was their problem only and their own responsibility 43 and that quitting was only a matter of their own will to start the process 47 . Similarly, other patients stated that the “smoking cessation topic” was to be initiated by themselves only and not by PCPs, except when it was directly relevant to the medical issue they were seeking help for.…”

“…For patients, good practices involved using a respectful tone, sensitivity to the patient’s receptivity, understanding the patient as an individual, being supportive, and neither “preaching” 47 , nor “pushing” 41 . On that matter, some PCPs used a “testing the water” strategy, that is to introduce the subject in “baby steps“ 58 —using verbal and non-verbal cues to assess whether patients were motivated to stop smoking or not 57 —or “small talk” 42 taking every opportunity to provide the information, especially with humor 40 .…”

“…Both underlined the importance of PCPs having an approach, based on respect and comprehension 41 , 47 , 51 . PCPs considered this approach as part of a relationship of trust that supports, encourages, and sustains behavioral change, with an idea of mutuality in the conversation 40 , 46 , 48 , 58 .…”

“…Few patients suggested that PCPs should try to scare them into quitting, with visual images illustrating the health consequences of smoking. Yet, paradoxically, the same patients stated they would not quit if confronted by a major personal smoking health shock 47 . This confrontation strategy was described by PCPs as “firm”, “strong”, “more direct”, “more forceful,” and “telling patients off,” but also criticized as nagging” 58 .…”

"I did not intend to stop. I just could not stand cigarettes any more." A qualitative interview study of smoking cessation among the elderly

“…In addition only a minority of GPs seem to advise their smoking patients about stopping [17]. One reason for their reluctance to intervene was given in a study by Guassora et al [18]: the interviewed GPs said more problems were produced than solved by discussing smoking cessation in "every" GP consultation. If the GP gives advice not consonant with what the patient expects, trust can be strained [19].…”