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Activating patients for smoking cessation through physician autonomy support.
Med Care. 2001 Aug; 39(8):813-23.MC

Abstract

OBJECTIVE

Test whether physicians' counseling patients for smoking cessation with an autonomy supportive rather than controlling style would increase patients' active involvement in the counseling session and increase maintained abstinence.

DESIGN

Randomized trial of 27 community-based physicians using two interview styles, with observer ratings of patient active involvement and assessments of patient smoking status at 6 months, 12 months, and 30 months.

PATIENTS

Adult smokers: 336 recruited; 249 for final analyses.

INTERVENTION

Physicians used an autonomy- supportive or controlling interpersonal style, randomly assigned within physician, to briefly counsel patients about smoking cessation, using the National Cancer Institute's 4-A's model.

MEASUREMENT

Patient active involvement was rated from audio tapes of the interviews. Continuous abstinence came from self-reports at 6 months, 12 months, and 30 months, CO validated at 6 months or 12 months and at 30 months.

RESULTS

Physician style did not have a significant direct effect on smoking cessation but did significantly increase patient active involvement in the interview. Active involvement, in turn, increased smoking cessation. Structural equation modeling confirmed a theoretical model in which the intervention positively predicted patient active involvement after controlling for patient reports of wanting to stop smoking, and active involvement significantly predicted continuous abstinence after controlling for previous quit attempts.

CONCLUSIONS

Although physicians' autonomy- supportive style while counseling smokers to quit did not have a direct effect on smoking cessation, it increased patients' active involvement in the counseling session which in turn increased continuous abstinence over 30 months. Further research should clarify the direct effects of physician interpersonal style on health outcomes.

Authors+Show Affiliations

Department of Medicine, University of Rochester, New York, USA. Geoffrey_Williams@urmc.rochester.eduNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11468500

Citation

Williams, G C., and E L. Deci. "Activating Patients for Smoking Cessation Through Physician Autonomy Support." Medical Care, vol. 39, no. 8, 2001, pp. 813-23.
Williams GC, Deci EL. Activating patients for smoking cessation through physician autonomy support. Med Care. 2001;39(8):813-23.
Williams, G. C., & Deci, E. L. (2001). Activating patients for smoking cessation through physician autonomy support. Medical Care, 39(8), 813-23.
Williams GC, Deci EL. Activating Patients for Smoking Cessation Through Physician Autonomy Support. Med Care. 2001;39(8):813-23. PubMed PMID: 11468500.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Activating patients for smoking cessation through physician autonomy support. AU - Williams,G C, AU - Deci,E L, PY - 2001/7/27/pubmed PY - 2001/9/14/medline PY - 2001/7/27/entrez SP - 813 EP - 23 JF - Medical care JO - Med Care VL - 39 IS - 8 N2 - OBJECTIVE: Test whether physicians' counseling patients for smoking cessation with an autonomy supportive rather than controlling style would increase patients' active involvement in the counseling session and increase maintained abstinence. DESIGN: Randomized trial of 27 community-based physicians using two interview styles, with observer ratings of patient active involvement and assessments of patient smoking status at 6 months, 12 months, and 30 months. PATIENTS: Adult smokers: 336 recruited; 249 for final analyses. INTERVENTION: Physicians used an autonomy- supportive or controlling interpersonal style, randomly assigned within physician, to briefly counsel patients about smoking cessation, using the National Cancer Institute's 4-A's model. MEASUREMENT: Patient active involvement was rated from audio tapes of the interviews. Continuous abstinence came from self-reports at 6 months, 12 months, and 30 months, CO validated at 6 months or 12 months and at 30 months. RESULTS: Physician style did not have a significant direct effect on smoking cessation but did significantly increase patient active involvement in the interview. Active involvement, in turn, increased smoking cessation. Structural equation modeling confirmed a theoretical model in which the intervention positively predicted patient active involvement after controlling for patient reports of wanting to stop smoking, and active involvement significantly predicted continuous abstinence after controlling for previous quit attempts. CONCLUSIONS: Although physicians' autonomy- supportive style while counseling smokers to quit did not have a direct effect on smoking cessation, it increased patients' active involvement in the counseling session which in turn increased continuous abstinence over 30 months. Further research should clarify the direct effects of physician interpersonal style on health outcomes. SN - 0025-7079 UR - https://www.unboundmedicine.com/medline/citation/11468500/Activating_patients_for_smoking_cessation_through_physician_autonomy_support_ L2 - https://doi.org/10.1097/00005650-200108000-00007 DB - PRIME DP - Unbound Medicine ER -