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Comparing Primary Care Physicians' Smoking Cessation Counseling Techniques to Motivational Interviewing

Werner, James J. PhD, MSSA; Lawson, Peter J. MA, MPH; Panaite, Vanessa MA; Step, Mary M. PhD; Flocke, Susan A. PhD

doi: 10.1097/ADM.0b013e3182879cc5
Original Research

Objectives: This study examined the degree of similarity between motivational interviewing (MI) methods and smoking cessation techniques that are routinely used by primary care physicians. Its purpose was to inform the development of more effective MI-based health behavior change training programs for primary care physicians.

Methods: Visits to primary care physicians were audio-recorded in northeast Ohio from 2005 to 2008. Doctor-patient talk about smoking cessation (n = 73) was analyzed for adherence to MI using the Motivational Interviewing Skills Code (MISC) version 2.1 behavioral coding system. Participating physicians were not provided with MI training as part of the study and were blinded as to the study's purpose.

Results: Physicians displayed MI adherent behaviors in 56% of discussions and MI nonadherent behaviors in 57%. The most common MI adherent statements involved affirming the patient; least common were requests for the patient's permission before raising concerns. The most frequent MI nonadherent behaviors were directing, confronting, and warning the patient. Physicians made simple reflections and complex reflections in 36% and 25% of visits, respectively.

Conclusions: Physicians used both MI adherent and MI nonadherent behaviors in approximately equal proportions, suggesting a base of MI adherent smoking cessation counseling skills upon which additional MI skills can be built. Efforts to improve smoking-cessation effectiveness may involve providing training in brief MI models and additional MI skills, while reinforcing physicians' current use of MI adherent methods.

From the Department of Family Medicine and Community Health (JJW, PJL, MMS, and SAF), Mandel School of Applied Social Sciences (JJW), Behavioral Measurement and Practice-Based Research Network Shared Resources of the Case Comprehensive Cancer Center (JJW and SAF), and Department of Epidemiology and Biostatistics (SAF), Case Western Reserve University, Cleveland, OH; Clinical and Translational Science Collaborative of Cleveland, Cleveland, OH (JJW); Department of Psychology, University of South Florida, Tampa, FL (VP).

Send correspondence and reprint requests to James J. Werner, PhD, MSSA, Department of Family Medicine and Community Health, Case Western Reserve University, 11000 Cedar Avenue, Suite 402, Cleveland, OH 44106. E-mail:

Supported by the National Cancer Institute, National Institutes of Health, through grant R01CA105292, and by the Clinical and Translational Science Collaborative of Cleveland, UL1TR000439, from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

The authors declare no conflicts of interest.

Received September 12, 2012

Accepted January 12, 2013

© 2013 American Society of Addiction Medicine