Management of smokers motivated to quit: a qualitative study of smokers and GPs.
BACKGROUND
The National Institute for Health and Clinical Excellence (NICE) guidelines state that GPs should manage smokers motivated to quit by offering referral to Stop Smoking Services (SSS) and that nicotine addiction treatment (NAT) should be offered only to those who decline referral.


OBJECTIVE
To explore how smokers motivated to quit are managed in the GP consultation, specifically how treatment and referral are negotiated from the perspectives of both parties.


METHODS
Twenty patients, identified in a consultation with their GP as motivated to quit smoking, and 10 participating GPs were interviewed. Interviews were recorded, transcribed, coded and analysed using the framework approach.


RESULTS
Three strategies (treatment and follow-up by the GP, referral to SSS without treatment and immediate treatment with referral for follow-up) were evidenced in patient and GP accounts. Most patients were satisfied with their management and how this was negotiated, but some expressed surprise or dissatisfaction with lack of immediate treatment and questioned the need for referral to SSS. GPs welcomed the availability of SSS but some felt it important that they themselves also continued to support a quit attempt. Several saw advantages in offering NAT at the time the patient was motivated to stop.


CONCLUSIONS
Smokers appear less convinced than GPs about the value of referral to SSS, although these differences may be resolved through negotiation. An alternative strategy to that proposed by NICE, which may be more acceptable to some smokers, is immediate treatment with subsequent support from SSS.
Wilson
Andrew
A
Department of Health Sciences, University of Leicester, Leicester, UK. aw7@le.ac.uk
Agarwal
Shona
S
Bonas
Sheila
S
Murtagh
Ged
G
Coleman
Tim
T
Taub
Nicholas
N
Chernova
Julia
J
D001291:Attitude of Health Personnel; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D009042:Motivation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011364:Professional Practice; D036301:Qualitative Research; D012017:Referral and Consultation; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology; D006113:United Kingdom