title: Sequence-analysis of video-recorded practitioner-patient communication about smoking in general practice: do smokers express negative statements about quitting?
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Leiden University Medical Centre, Department of Public Health and Primary Care, Leiden, The Netherlands. Electronic address: m.e.a.verbiest@lumc.nl.
authors.forename: Marjolein E A
authors.initials: ME
authors.lastname: Verbiest
authors.affiliation: Leiden University Medical Centre, Department of Public Health and Primary Care, Leiden, The Netherlands.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Chavannes
authors.affiliation: Leiden University Medical Centre, Department of Public Health and Primary Care, Leiden, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Passchier
authors.affiliation: Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: Noordman
authors.affiliation: Leiden University Medical Centre, Department of Medical Psychology, Leiden, The Netherlands.
authors.forename: Margreet
authors.initials: M
authors.lastname: Scharloo
authors.affiliation: Leiden University Medical Centre, Department of Medical Psychology, Leiden, The Netherlands.
authors.forename: Ad A
authors.initials: AA
authors.lastname: Kaptein
authors.affiliation: Leiden University Medical Centre, Department of Public Health and Primary Care, Leiden, The Netherlands; Radboud University Nijmegen Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands.
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
authors.affiliation: Leiden University Medical Centre, Department of Public Health and Primary Care, Leiden, The Netherlands.
authors.forename: Mathilde R
authors.initials: MR
authors.lastname: Crone
mesh_terms: D000368:Aged; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D058006:General Practice; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D011369:Professional-Patient Relations; D012017:Referral and Consultation; D012907:Smoking / Q000009:adverse effects* / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*; D012959:Socioeconomic Factors; D014741:Video Recording
keywords: Communication; General practice; Physician–patient relations; Sequence analysis; Smoking cessation; Video recording