Sequence-analysis of video-recorded practitioner-patient communication about smoking in general practice: Do smokers express negative statements about quitting?

PATIENT EDUCATION AND COUNSELING

卷:97

Article

Verbiest, Marjolein E. A.¹  Chavannes, Niels H.¹  Passchier, Esther¹  Noordman, Janneke²  Scharloo, Margreet³  Kaptein, Ad A.³  Assendelft, Willem J. J.^1,4  Crone, Mathilde R.¹ 

[1] Leiden Univ, Med Ctr, Dept Publ Hlth & Primary Care, NL-2300 RC Leiden, Netherlands

[2] Netherlands Inst Hlth Serv Res, Utrecht, Netherlands

[3] Leiden Univ, Med Ctr, Dept Med Psychol, NL-2300 RC Leiden, Netherlands

[4] Radboud Univ Nijmegen, Med Ctr, Dept Primary & Community Care, NL-6525 ED Nijmegen, Netherlands

关键词: General practice;    Smoking cessation;    Physician-patient relations;    Communication;    Video recording;    Sequence analysis;   

DOI  :  10.1016/j.pec.2014.08.006

来源: Elsevier

【 摘 要 】

Objective: To examine the extent to which smokers express negative statements about quitting and the extent to which these statements influence general practitioners' (GPs') and practice nurses' (PNs') (dis)continuation of guideline-recommended smoking cessation care. Methods: Fifty-two video-consultations were observed (GP-consultations: 2007-2008; PN-consultations: 2010-2011). Dialogues were transcribed verbatim and professionals' and patients' speech units were coded and analysed using sequential analyses (n = 1424 speech units). Results: GPs focused on asking about smoking (GPs: 42.4% versus PNs: 26.2%, p = 0.011) and advising them to quit (GPs: 15.3% versus PNs: 3.5%, p < 0.001), whereas PNs focused on assisting them with quitting (GPs: 25.4% versus PNs: 55.2%, p < 0.001). Overall, patients expressed more negative statements about quitting than positive statements (negative: 25.3% versus positive: 11.9%, p < 0.001), especially when PNs assessed their willingness to quit (OR 3.61, 95% CI 1.44-9.01) or assisted them with quitting (OR 2.23, 95% CI 1.43-3.48). Practice implications: An alternative approach to smoking cessation care is proposed in which GPs' tasks are limited to asking, advising, and arranging follow-up. This approach seems the least likely to evoke negative statements of patients about quitting during dialogues with GPs and is compatible with the tasks and skills of PNs who could, subsequently, assist smokers with quitting. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

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