Activating patients for smoking cessation through physician autonomy support

OBJECTIVE. Test whether physicians' counseling patients for smoking cessati on with an autonomy supportive rather than controlling style would increase patients' active involvement in the counseling session and increase mainta ined abstinence. DESIGN. Randomized trial of 27 community-based physicians using two intervi ew styles, with observer ratings of patient active involvement and assessme nts 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 interpe rsonal style, randomly assigned within physician, to briefly counsel patien ts about smoking cessation, using the National Cancer Institute's 4-A's mod el. MEASUREMENT. Patient active involvement was rated from audio tapes of the i nterviews. Continuous abstinence came from self-reports at 6 months, 12 mon ths, 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 smokin g cessation but did significantly increase patient active involvement in th e interview. Active involvement, in turn, increased smoking cessation. Stru ctural equation modeling confirmed a theoretical model in which the interve ntion positively predicted patient active involvement after controlling for patient reports of wanting to stop smoking, and active involvement signifi cantly predicted continuous abstinence after controlling for previous quit attempts. CONCLUSIONS. Although physicians' autonomy-supportive style while counselin g smokers to quit did not have a direct effect on smoking cessation, it inc reased patients' active involvement in the counseling session which in turn increased continuous abstinence over 30 months. Further research should cl arify the direct effects of physician interpersonal style on health outcome s.