The consultation in general practice as a context for a mass strategy of smoking cessation advice

1. The consultation in general practice as a context for a mass strategy of smoking cessation advice Balancing smoking cessation advice with trust, morality, and relevance PhD-dissertation by Ann Dorrit Guassora The Department and Research Unit for General Practice, University of Copenhagen

2. Background High-risk strategy Mass strategy

3. Aims How general practice consultations will work as a context for a mass strategy of smoking cessation advice? The influence that advice has on the patient-GP relationship and the influence that the patient-GP relationship has on advice

4. Con- sultation Con- sultation Con- sultation Con- sultation Con- sultation Compasrison of perspevtives Comparison of perspectives Comparison oaf perspectives Comparison oaf perspectives Comparison oaf perspectives GP interview GP interview Patient interview GP interview Patient interview Patient interview Patient interview Patient interview GP interview GP interview F E D C Methods B Surgery A Con- sultation Comparison of perspectives Patient interview GP interview Consultations regarding health problems not related to smoking

5. Results Relevance criteria - the illness in question - many other occasions - the patient’s general well-being Cheryl: “…Those are the kind of days where I decide to just relax, just be myself with my dog, right. And I am. I have the answering machine turned on, on the phone. Just in case something should happen to my father or my daughter or something like that. It feels good to just go in and listen to it, now and then, right. But otherwise, yes, that’s what I do.” GP B: “You once talked about doing something about smoking too?”

6. Results Morality and mutuality Ideals of moral acceptance of patients were challenged Mutuality was at stake when smoking cessation advice was repeated Sophie: “I certainly know what she [GP C] thinks of smoking and she has made it clear many times, so I think we’ve kind of put that behind us. Of course, she would mention it if I attended with some illness. (…) again it’s about equality and mutual respect, right, ‘cause she knows very well that I know that smoking is by God unhealthy and the damage it does. I think she is aware that I understand that…”

7. Results Patients’ trust in their GP The GP is not accepting the responsibility to evaluate and possibly solve the patients’ health problems ”Do you smoke?” ”Yes” ”Then that’s why”. “Next”. (Alice) That the GPs do not recognize the patients’ health problems That the GP showed interest for him/her Trust was seen by GPs and patients as a resource for smoking cessation advice

8. Implications Adaptation of methods Presenting advice as a campaign - separating it from routine consultations Situating smoking cessation advice in an acceptable manner - skills would need to be improved

10. What did the study add? Addressing the patient’s well-being Frequent repetition of advice was a challenge to mutuality Maintenance of trust demanded that smoking cessation advice was given in a manner that fitted the rules of conduct