title: Patient perspectives on tobacco use treatment in primary care.
abstract: BACKGROUND
  Evidence-based tobacco cessation interventions increase quit rates, yet most smokers do not use them. Every primary care visit offers the potential to discuss such options, but communication can be tricky for patients and provider alike. We explored smokers' personal interactions with health care providers to better understand what it is like to be a smoker in an increasingly smoke-free era and the resources needed to support quit attempts and to better define important patient-centered outcomes.
  
  
  METHODS
  Three 90-minute focus groups, involving 33 patients from 3 primary care clinics, were conducted. Participants were current or recent (having quit within 6 months) smokers. Topics included tobacco use, quit attempts, and interactions with providers, followed by more pointed questions exploring actions patients want from providers and outcome measures that would be meaningful to patients.
  
  
  RESULTS
  Four themes were identified through inductive coding techniques: 1) the experience of being a tobacco user (inconvenience, shame, isolation, risks, and benefits), 2) the medical encounter (expectations of providers, trust and respect, and positive, targeted messaging), 3) high-value actions (consistent dialogue, the addiction model, point-of-care nicotine patches, educational materials, carbon monoxide monitoring, and infrastructure), and 4) patient-centered outcomes.
  
  
  CONCLUSIONS
  Engaged patient-centered smoking cessation counseling requires seeking the patient voice early in the process. Participants desired honest, consistent, and pro-active discussions and actions. Participants also suggested creative patient-centered outcome measures to consider in future research.
authors: University of North Carolina at Chapel Hill, Department of Family Medicine, 590 Manning Dr, Chapel Hill, NC 27599. E-mail: jacqueline_halladay@med.unc.edu. Dr Halladay is also affiliated with the Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina.
authors: Jacqueline R
authors: JR
authors: Halladay
authors: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Maihan
authors: M
authors: Vu
authors: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Carol
authors: C
authors: Ripley-Moffitt
authors: Community-Based Family Practice Physicians, Cary, North Carolina.
authors: Sachin K
authors: SK
authors: Gupta
authors: Community-Based Family Practice Physicians, Cary, North Carolina.
authors: Christine
authors: C
authors: O'Meara
authors: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Adam O
authors: AO
authors: Goldstein
mesh_terms: D003376:Counseling / Q000379:methods*; D017144:Focus Groups; D006801:Humans; D015994:Incidence; D009042:Motivation; D011320:Primary Health Care / Q000379:methods*; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods*; D064424:Tobacco Use / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology
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