Study shows how primary care providers can influence smoking cessation

Motivational interviewing (MI), a counseling approach that uses a person’s own internal drive to initiate change, can increase the likelihood that a patient will change smoking behaviors, according to a University of Louisville study published in the Southern Medical Journal. The study tested the effects of different approaches to smoking cessation counseling offered in primary care clinics.

Although smoking rates have decreased over the past 40 years, smoking is still the most common preventable cause of death in the United States, and the costs remain high for treating diseases associated with smoking. The study, led by S. Lee Ridner, PhD, associate professor, UofL School of Nursing, consisted of 84 patients divided into three groups. The control group received no MI. The second group experienced MI with a medical doctor (MD), and the third group took part in MI with a physician and a registered nurse (RN). The MI intervention for the MD group consisted of a five- to ten-minute session focused on changing habits and creating a plan for smoking cessation. The third group received the same five- to ten-minute session with the MD plus a follow-up telephone call approximately two weeks later from the RN. The follow-up session focused on the same processes and provided a “booster” session for the patients.

The long-term impact of the study is unclear because of the limited follow-up period, but the researchers did find that MI had a positive impact on smoking behaviors. Nicotine dependence decreased more quickly over time in the group counseled by both doctors and nurses than it did in the control group.

Ridner said the study was as much about changing the attitude of health care providers as much as the attitude of smokers.

“As health care providers, we have talked at people far too long. Basically, we keep saying, ‘You need to quit smoking!’ Motivational interviewing is a way to engage patients in conversations so that we can help them identify their reasons to change,” he said. By understanding the deeper motivations behind a person’s decision to adjust or quit their smoking habits, such as family or health concerns, medical professionals can tailor the MI to each patient. Ridner hopes that this specific approach will increase smoking cessation rates among recipients of MI.

According to Ridner, the study shows how primary care providers can influence smoking cessation by using more patient-centered counseling approaches. Helping patients resolve some of the ambivalence they have about their smoking behaviors can have a long-lasting impact and help decrease tobacco use, he said.