Motivational consulting versus brief advice for smokers in general practice: A randomized trial

Background. Theoretical and clinical developments suggestthat opportunistic interventions could be developedthat are more effective and satisfying to use than briefadvice to quit smoking. Motivational consulting was influencedby the ‘stages of change’ model, self-efficacy theory,motivational interviewing, and the patient-centred clinicalmethod.Aim. To compare the clinical and cost-effectiveness of motivationalconsulting with brief advice to quit smoking.Method. Pragmatic randomized trial in 21 general practicesin South Wales: 536 cigarette smokers consulting with 24general practice registrars were randomized to receive motivationalconsulting (270 patients) or brief advice (266patients) during one consultation. Costs of training physiciansand the extra consultation time for motivational interviewingwere assessed. Outcomes were documented on418 subjects (78%) at six-month follow-up.Results. Significantly more patients in the motivational consultinggroup reported not smoking in the previous 24 hours(P = 0.01), delaying their first cigarette of the day more thanfive minutes after waking (P = 0.01), making an attempt toquit lasting at least a week during follow-up (P = 0.04), andbeing in a more ready stage of change (P = 0.05). Non-significanttrends favoured motivational consulting for selfreportabstention from smoking for one month, making anattempt to quit, and for reducing smoking. The advantage ofmotivational consulting was greatest among those initiallynot thinking of giving up in the following six months. Cost oftraining was £69.50 per physician, and cost of extra consultationtime was £13.59 per patient.Conclusions. Motivational consulting produces better outcomesthan brief advice, especially among those not ‘readyto change’. This supports the stages of change model.Overall, however, few patients quit. More intensive trainingmight produce better outcomes.