Impact of the frequency of advice to quit smoking and experience of care in general practice

Problem

General Practitioners (GPs) have an important role in motivating and supporting patients who smoke to quit. Qualitative studies suggest that GPs hold concerns that conversations about smoking cessation may negatively influence doctor-patient relationship and experience of care. We conducted an online survey to determine if experience of care differed between smokers and ex-smokers and the influence of advice to quit smoking on experience of care and patient ratings of care received from GPs.

Approach

Current and ex-smokers (quit within the past 5 years) were invited to complete an online survey about experience of care in general practice in the past 12 months. The survey was advertised online through social media across all Australian states and territories. Validated questions were used to assess patient experience of care and anticipated stigma. Care received from GPs was rated on a 10 point scale (higher scores indicated higher rating of care). Smokers were asked how important it was for them to quit, how often GPs had advised them to quit in the past 12 months, if they were advised in a way that motivated them to quit, and if they had tried to quit.

Findings

Respondents included n=611 current and n=275 ex-smokers. Respondents’ ages ranged from 35-83 years (mean 60 ± 9.5). Relational experiences of care did not differ between smokers and ex-smokers (feeling listened to, being shown respect, having enough time with GP), however, smokers reported poorer access (p=0.042) and were more likely to delay seeking care from GPs (p=0.006). Smokers were more likely to anticipate stigma in GP clinics (p<0.001), but overall rating of care received from GPs did not differ between smokers and ex-smokers. Nearly all (85.2%) smokers reported that quitting was ‘important’ or ‘very important’ to them and 64% had tried to quit in the past 12 months. Almost half (48.8%) reported ‘usually’ or ‘always’ being advised to quit and 43% reported being advised in a way that made them feel motivated to try. Smokers who ‘always’ or ‘usually’ were advised to quit rated care from GPs more highly (8.1 vs 7.7/10, p=0.016). Despite this, they were more likely to report delaying seeking care (71.6% vs 60.3%; p=0.005) and higher anticipated stigma (10.4 (3.7) vs 9.6 (3.8); p=0.004).

Consequences

Consistent with other studies, smokers who were more frequently advised to stop smoking reported better health care experiences and rated GPs more highly. Conversely, these patients were more likely to delay seeing their GP and anticipation of stigma was higher. Frequent advice to quit smoking appears acceptable to patients and may reflect better quality care more generally, however GPs should endeavour to provide advice and support that motivates and does not exacerbate feelings of shame, guilt or stigma.