Patient Engagement During Medical Visits and Smoking Cessation Counseling

JAMA Internal Medicine

Importance: Increased patient engagement with health and health care is considered crucial to increasing the quality of health care and patient self-management of health.

Objective: To examine whether patients with high levels of engagement during medical encounters are more likely to receive advice and counseling about smoking compared with less engaged patients.

Design, Setting and Participants: Cross-sectional survey using multivariate regression analysis of 8656 current and retired autoworkers and their spouses younger than 65 years who are or were employed by the 3 major US auto companies.

Results: Among 1904 current smokers, 58.5% of those who were more highly engaged during medical encounters were counseled by clinicians about specific strategies and methods to stop smoking, compared with 45.4% of patients who were less engaged. Patient engagement and being advised by clinicians to stop smoking had independent effects on smoking cessation efforts by patients. Accounting for differences in other patient characteristics, patients with high engagement levels were more likely to try to stop smoking compared with patients with lower engagement (odds ratio, 1.62;P < .01). Patients who were both highly engaged and had received counseling from clinicians were the most likely to try to stop smoking (74.6%) while patients with low engagement who did not receive counseling were the least likely (46.0%). Nevertheless, counseling is still effective among even less engaged patients; 60.4% of smokers with low engagement who received counseling tried to quit smoking in the past year compared with 46.0% who did not receive counseling.

Conclusions and Relevance: The study results provide evidence that clinicians respond differently to patients who are highly engaged during medical encounters than they do to less engaged patients in terms of smoking cessation advice. Clinicians should not assume that low patient engagement and greater passivity during medical encounters is evidence of unwillingness to quit. The results show that smoking cessation counseling is associated with a higher likelihood of quit attempts even for patients who are less engaged during medical

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