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Background. Theoretical and clinical developments suggest that opportunistic interventions could be developed that are more effective and satisfying to use than brief advice to quit smoking. Motivational consulting was influenced by the ‘stages of change’model, self-efficacy theory, motivational interviewing, and the patient-centred clinical method.

Aim. To compare the clinical and cost-effectiveness of motivational consulting with brief advice to quit smoking. Method. Pragmatic randomized trial in 21 general practices in South Wales: 536 cigarette smokers consulting with 24 general practice registrars were randomized to receive motivational consulting (270 patients) or brief advice (266 patients) during one consultation. Costs of training physicians and the extra consultation time for motivational interviewing were assessed. Outcomes were documented on 418 subjects (78%) at six-month follow-up. Results …