Qualitative study of patients' perceptions of doctors' advice to quit smoking: implications for opportunistic health promotion.

OBJECTIVES: To determine the effectiveness and acceptability of general practitioners'opportunistic antismoking interventions by examining detailed accounts of smokers' experiences of these.
DESIGN: Qualitative semistructured interview study.
SETTING: South Wales.
SUBJECTS: 42 participants in the Welsh smoking intervention study were asked about initial smoking, attempts to quit, thoughts about future smoking, past experiences with the health services, and the most appropriate way for health services to help them and other smokers.
RESULTS: Main emerging themes were that subjects already made their own evaluations about smoking, did not believe doctors' words could influence their smoking, believed that quitting was down to the individual, and felt that doctors who took the opportunity to talk about smoking should focus on the individual patient. Smokers anticipated that they would be given antismoking advice by doctors when attending for health care; they reacted by shrugging this off, feeling guilty, or becoming annoyed. These reactions affected the help seeking behaviour of some respondents. Smokers were categorised as "contrary," "matter of fact," and "self blaming," depending on their reported reaction to antismoking advice.
CONCLUSIONS: Doctor-patient relationships can be damaged if doctors routinely advise all smokers to quit. Where doctors intervene, a patient centred approach-one that considers how individual patients view themselves as smokers and how they are likely to react to different styles of intervention-is the most acceptable.