title: Comparing primary care physicians' smoking cessation counseling techniques to motivational interviewing.
abstract: OBJECTIVE
  This study examined the degree of similarity between motivational interviewing (MI) methods and smoking cessation techniques that are routinely used by primary care physicians. Its purpose was to inform the development of more effective MI-based health behavior change training programs for primary care physicians.
  
  
  METHODS
  Visits to primary care physicians were audio-recorded in northeast Ohio from 2005 to 2008. Doctor-patient talk about smoking cessation (n = 73) was analyzed for adherence to MI using the Motivational Interviewing Skills Code (MISC) version 2.1 behavioral coding system. Participating physicians were not provided with MI training as part of the study and were blinded as to the study's purpose.
  
  
  RESULTS
  Physicians displayed MI adherent behaviors in 56% of discussions and MI nonadherent behaviors in 57%. The most common MI adherent statements involved affirming the patient; least common were requests for the patient's permission before raising concerns. The most frequent MI nonadherent behaviors were directing, confronting, and warning the patient. Physicians made simple reflections and complex reflections in 36% and 25% of visits, respectively.
  
  
  CONCLUSIONS
  Physicians used both MI adherent and MI nonadherent behaviors in approximately equal proportions, suggesting a base of MI adherent smoking cessation counseling skills upon which additional MI skills can be built. Efforts to improve smoking-cessation effectiveness may involve providing training in brief MI models and additional MI skills, while reinforcing physicians' current use of MI adherent methods.
authors.affiliation: Department of Family Medicine and Community Health, Mandel School of Applied Social Sciences, Behavioral Measurement and Practice-Based Research Network Shared Resources of the Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA. james.werner@case.edu
authors.forename: James J
authors.initials: JJ
authors.lastname: Werner
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Lawson
authors.forename: Vanessa
authors.initials: V
authors.lastname: Panaite
authors.forename: Mary M
authors.initials: MM
authors.lastname: Step
authors.forename: Susan A
authors.initials: SA
authors.lastname: Flocke
mesh_terms: D003376:Counseling / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods / Q000706:statistics & numerical data; D009820:Ohio; D010349:Patient Compliance / Q000706:statistics & numerical data; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data*; D016896:Treatment Outcome