Physician delivery of smoking-cessation advice based on the stages-of-change model

The purpose of this study is to assess whether a stage-based program of brief physician-delivered smoking-cessation advice changes smoking stages of readiness to quit smoking. First-year residents were trained to assess the stage of their continuity care patients who smoke, using Prochaska and DiClemente's methods, and to deliver brief messages and handouts based on the stages of precontemplation, contemplation, and action. Concurrent with the training, we administered a survey to 252 smokers, before their physician encounter. Eighty-nine smokers saw trained residents (intervention group), and 163 saw untrained residents (usual care group). A follow-up survey was administered six months later. Seventy-four percent of the subjects completed the follow-up survey. After we controlled for baseline stage, the percentage of precontemplators was lower in the intervention group (25%) than in the usual care group (36%) (P < .05, log-linear model). In the intervention group, 50% of the subjects had positive stage shifts versus 40% in the usual care group (P = .2). Subjects in the intervention group moved ahead a mean of 0.63 stage per subject, whereas subjects in the usual care group moved ahead 0.34 stage per subject (P < .05). The self-reported cessation rate was 15.5% and did not differ between the two groups. We conclude that our stage-specific brief advice program enhances short-term movement through the stages-of-change of smoking cessation. Measurement of this movement may be an important intermediary in evaluating small clinical trials of brief advice. Our findings indicate potential benefits of a staged approach for both clinicians and their patients.