Table 2

Patient and Clinician Views on Testing Extracted From Qualitative Interviews

ThemeaDescriptionQuotation (Source)
Testing is generally a good ideaLarge majority (89%) of patients believed that testing women for smoking during pregnancy would be positive for women and their pregnancies. It is important to note that these statements were not mutually exclusive from concerns about testing and the impact it would have on their relationship with clinicians.“I think these tests, like the urine tests and the drug tests, is good for the mothers just so that the doctors will know and try to get treatment and help for the mothers.” (Focus group 4)
“Why do I think it’s a good way to check? … I’m thinking of it just in terms of helping other women just to keep that positive reinforcement going.” (Patient aged 37 years, Postpartum)
Testing would increase disclosureMost patients believed that testing women for tobacco use would increase the number who disclosed their smoking status to clinicians and help women in making this disclosure.“I’d try to tell them before it [the test] come back. ‘Look, I did want to tell you, but I know these results are going to come back, so I might as well go ahead and tell you that I smoke 3 cigarettes a day. You know it was 10, but now it’s 3. I’m trying to cut back. So if you can give me any options or resources that can help me go ahead and quit, let’s go ahead and get down to the nitty gritty.’ That’s how it would be.” (Focus group 2)
“… with seeing the results and doing the test that would motivate me to be like okay, maybe I should just go ahead and tell my doctor the truth and let him know what’s going on so we can just stop it right there.” (Patient aged 27 years, pregnant)
Testing may have some negative effect on relationshipAlthough only one-third of women expressed that testing would have negatively affect their relationship with clinicians, more than 80% of clinicians expressed this view. In general, clinicians expressed more concern about patient privacy and the potential punitive nature of the test.“If you come out telling the truth, then you and your doctor have a good relationship, but if they feel like you’re a liar and you prove that you’re a liar, then your doctor will probably feel different, maybe become impatient because they always think that you’re lying.” (Patient aged 18 years, pregnant)
“I’d worry about it. It’s the same thing with the uTox screens. You have the potential to really ruin that relationship…” (Attending physician)
“… a patient will get angry if they have a false-positive for a test they don’t believe they deserve and a cynical provider might say, ‘You
should believe the test and not the patient.’ …” (Attending physician)
Testing will increase cessationThe majority (81%) of women expressed the view that testing for tobacco use would increase smoking cessation.“It’s a good way because like I said, if they want to stop smoking, then this test will actually help them out, but if they already know that they’re smoking and they’re not willing to try and stop, there’s no need.” (Patient aged 18 years, pregnant)
Testing will have no effect on cessation“Because if your mind already set on doing something, you are going to set your mind on that and you are going to do what you want to do.” (Focus group 1)
“Some people just need more assistance to stop. So that [the test] just might open up the doors a little bit more for that extra help that they need to stop smoking.” (Patient aged 27 years, pregnant)
  • uTox = urine toxicology.

  • a Themes listed are a selection from those developed as described in Methods.