Boesch Anne, Durand Marie-Anne, Habfast-Robertson Ines, Jacot-Sadowski Isabelle, Berlin Ivan, Selby Kevin
University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland.
The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.
Tob Use Insights. 2024 Dec 12;17:1179173X241304271. doi: 10.1177/1179173X241304271. eCollection 2024.
Medications for smoking cessation can double quit rates but are underused in primary care. This qualitative study aimed to explore: (1) patients' perspectives regarding having their general practitioner (GP) use a proactive approach to smoking cessation treatment using an encounter decision aid (DA), and (2) their expectations regarding their GP's role. We conducted qualitative semi-structured interviews with participants of the FIRST randomized trial (adults who smoke daily with any level of motivation for tobacco quitting). In the FIRST study, the intervention was a half-day course teaching GPs to use a proactive approach using a DA. Control GPs received a 1-h refresher training. Phone interviews were run 5-16 weeks after a routine visit with their GP. A thematic data analysis was performed with 20% double independent coding. We conducted 20 semi-structured interviews (mean age 49 years, 55% female). In the intervention group (n = 12), 7 participants appreciated the DA, saw it as useful, usable, and valuable. Two participants did not find it helpful and 3 did not recall having used it. Participants felt their GP provided moral support, more than from a specialist (cardiologist or pulmonologist) because their GP knows them better and has more time during the visit. They felt that the most important factor influencing smoking cessation was their own motivation, not treatment. Most participants appreciated the DA. Most participants did not perceive medications as part of quitting. They thought quitting was a matter of motivation. A DA could be an acceptable way to encourage use of treatments to aid with tobacco cessation. An early presentation of treatment options to all persons who smokes may encourage them to request a treatment when ready to quit smoking. Patient perceptions of the role of GPs and treatments for smoking cessation may be a barrier to seeking help to quit.
戒烟药物可使戒烟成功率翻倍，但在初级医疗保健中却未得到充分利用。这项定性研究旨在探讨：（1）患者对于其全科医生（GP）使用就诊决策辅助工具（DA）采取积极主动的戒烟治疗方法的看法，以及（2）他们对全科医生角色的期望。我们对FIRST随机试验的参与者（每天吸烟且有任何戒烟动机水平的成年人）进行了定性半结构化访谈。在FIRST研究中，干预措施是为全科医生提供一个为期半天的课程，教授他们使用决策辅助工具采取积极主动的方法。对照组的全科医生接受了1小时的复习培训。在与全科医生进行常规就诊后的5 - 16周进行电话访谈。采用20%的双重独立编码进行主题数据分析。我们进行了20次半结构化访谈（平均年龄49岁，55%为女性）。在干预组（n = 12）中，7名参与者赞赏决策辅助工具，认为它有用、易用且有价值。2名参与者认为它没有帮助，3名参与者不记得使用过它。参与者认为他们的全科医生提供的精神支持比专科医生（心脏病专家或肺病专家）更多，因为全科医生更了解他们，且在就诊时有更多时间。他们认为影响戒烟的最重要因素是他们自己的动机，而非治疗。大多数参与者赞赏决策辅助工具。大多数参与者并不认为药物是戒烟的一部分。他们认为戒烟是动机的问题。决策辅助工具可能是鼓励使用辅助戒烟治疗的一种可接受方式。向所有吸烟者尽早介绍治疗选择可能会鼓励他们在准备戒烟时寻求治疗。患者对全科医生角色和戒烟治疗的看法可能是寻求戒烟帮助的一个障碍。
