Raising the topic of smoking cessation in general practice
Research type
Research Study
Full title
Raising the topic of smoking cessation in general practice: applying conversation analysis to General Practitioner-patient consultations that mention smoking
IRAS ID
236511
Contact name
Rachna Begh
Contact email
Sponsor organisation
University of Oxford
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Summary of Research:
Background
Primary care practitioners are in a key position to support smokers to stop smoking, but many miss opportunities to intervene. Public health guidance recommends that practitioners deliver very brief advice (VBA) and offer support to smokers during consultations. The impact practitioners have in promoting the use of supported cessation depends upon how they deliver their messages. Although we teach doctors to deliver a set-piece form of intervention (VBA), the reality of consultations about smoking is very different and delivery of VBA in their intended format is probably uncommon.
Aims
We propose using pre-collected recorded consultations to examine how doctors succeed in or miss the chance to address smoking cessation.
Methods
We will use pre-collected data from a UK archive of primary care consultations. We will examine and analyse video-recordings and transcripts of consultations from the archive that include a reference to smoking. We will primarily use conversation analysis (CA) to examine whether, and how, the social interactional practices described by current interventions play out in real consultations, and provide a detailed picture of talk sequences associated with patient uptake of, or resistance to, advice and support. In addition, an established coding scheme for Behaviour Change Techniques and linked data (participant surveys and medical records) will be utilised.
How the results will be used
The findings will provide information on whether the assumptions, which are part of current interventions are correct; provide a more detailed picture of the practices described by them; add new dimensions to the understanding of these practices and suggest any missing links between current guidelines and what happens in practice. The findings will be used to identify effective ways of helping GPs engage with smokers about quitting, and opportunities for enhancing training and existing guidelines.Research Summary:
Background Doctors are in a key position to support their patients who smoke to stop smoking, but many are missing opportunities to provide advice and support on how to quit during consultations. The impact that doctors have in encouraging patients to stop smoking depends on how they deliver their messages. Although we teach doctors to deliver a set piece of advice on stopping smoking, known as ‘very brief advice’, the reality of consultations about smoking is very different and delivery of very brief advice in that way is probably uncommon. We used recordings of primary care consultations to look at how doctors either successfully talk about stopping smoking with their patients who smoke, or miss the chance to address it.Methods
We looked at 519 video-recordings from an archive of primary care consultations in England, for examples of where the doctor or the patient talked about smoking. We used a method known as conversation analysis to look at conversations between doctors and their patients, noting how patients responded to doctors who asked a question about smoking, gave advice about smoking and offered treatment to stop smoking.Results
In 31 out of 519 recordings it was clear that the patient smoked, and, in 25 out of 31 consultations, doctors raised the topic of smoking. They did so by asking about whether the patient smoked or not, commonly during the history-taking part of the consultation. In many instances, these questions led to patients showing active resistance to this line of questioning, particularly in cases where the doctor tried to establish how many cigarettes the patient smoked. Thereafter, where doctors returned to the topic of smoking, they did so typically by linking smoking to the patient’s medical condition, which likewise led to resistance. Guidance recommends that doctors advise on how best to quit smoking where patients are interested in doing so, but this was only seen in a small number of consultations. Where doctors offered support for stopping smoking, they did so in a way that lessened the need for the patient to respond and accept.Conclusions
Our findings have shown how common ways of talking about smoking during primary care consultations can lead to patient resistance and can stop conversations from progressing positively. Future research should look at when and how advice on how best to quit, and offers of support, should be delivered within primary care consultations.REC name
North West - Greater Manchester West Research Ethics Committee
REC reference
17/NW/0687
Date of REC Opinion
11 Dec 2017
REC opinion
Further Information Favourable Opinion