Smoking cessation advice in consultations with health problems not related to smoking? Relevance criteria in Danish general practice consultations

Objective. To identify frames of interaction that allow smoking cessation advice in general practice consultations. Design. Qualitative study based on individual in-depth interviews with GPs and their patients. Each of the GPs' consultations were observed during a three-day period. Interviews primarily addressed the consultations that had been observed. The concept of "frames" described by Goffman was deployed as an analytic tool. Setting. Danish general practice. Subjects. Six GPs and 11 of their patients. Results. Both GPs and patients evaluated potential issues to be included during consultations by relevance criteria. Relevance criteria served the purpose of limiting the number of issues in individual consultations. Issues could be included if they connected to something already communicated in a consultation. Smoking cessation advice was subject to these relevance criteria and was primarily discussed if it posed a particular risk to a particular patient. Smoking cessation advice also occurred in conversations addressing the patient's well-being. If occurring without any other readable frame, smoking cessation advice was apt to be perceived by patients as part of a public campaign. Conclusions. Relevance criteria in the shape of communication of particular risks to particular patients and small-talk about well-being reflect the concept of "frames" by Goffman. Criteria of relevance limit the number of issues in individual consultations. Relevance criteria may explain why smoking cessation advice has not yet been implemented in many more consultations.