Anti-smoking advice in general practice consultations : a description of the factors influencing provision of advice and the development of a method for describing smokers' responses

A random sample of GPs stratified by their attitudes towards discussing smoking with patients, each had one surgery session video-recorded. Attending patients completed questionnaires, which identified smokers and recorded their likelihood of attempting to quit smoking. The characteristics of patients and GPs who agreed and refused to be video-recorded were noted. GPs were shown video-recordings before semi-structured interviews explored their reasons for discussing or not discussing smoking during consultations. In a separate study, smokers' consulting behaviours were described.;Results.; GPs view advice-giving as a challenging task that they prefer to approach in a problem-based manner to preserve good doctor: patient relationships.; Behaviours, which may indicate smokers who are more likely to make quit attempts, are reliably and validly described.; Younger patients and those presenting with overt mental health problems are less likely to consent to video recording of consultations.; Younger GPs and those working in teaching and training practices are more likely to agree to video recording of consultations.;Conclusions.; Strategies to increase the provision of anti-smoking advice given by GPs should take into account GPs' preferences for giving advice in a problem-based manner.; Further research could produce methods of identifying, at the time of their consultations, smokers likely to respond positively to advice.; Researchers who use video-recorded consultations must consider how this technique could influence their study findings