Table 3

Patient Recommendations for Maintaining Trust in the Patient-Clinician Relationship With Cotinine Testing

RecommendationQuotation (Source)
Clinicians should acknowledge that patients expect them to be helpful“I mean, I don’t think it should affect the relationship because if anything the doctor is there to help and the patient is there to be seen.” (Patient aged 25 years, pregnant)
“It shouldn’t really affect their relationship. The doctor’s going to offer about quitting and everything. Stand by the patient. Keep encouraging the patient. So it shouldn’t affect the relationship.” (Patient aged 33 years, postpartum)
Clinicians must obtain consent before testing“Like, if the doctor doesn’t bring it up and then just puts the test on the unsuspecting woman, then that would create a trust issue with her and then she’s not going to be able to open up to the doctor…” (Patient aged 36 years, pregnant)
Clinicians should explain how testing can be helpful for the pregnancy“I mean I think that depending on how you frame it, it may or may not affect the relationship. If you make it so it’s like, ‘You know, you say you don’t smoke, but I’m going to make you take this test anyway because I don’t believe you,’ if you frame it like that, it’s going to damage the relationship. If you say, ‘We’re testing everybody for this so we can find out if we need to intervene and provide tips,’ I think people would be more receptive to it and not diminish the relationship.” (Resident physician)
Clinicians should avoid judgment of patient behaviors“I think just because maybe the doctor might look down on you, like you don’t care about your baby…” (Patient aged 27 years, pregnant)
“I really try to get them to be honest with us about what’s going on and I really try to make it nonjudgmental. This feels very judgmental. This feels like the opposite of what I try to do, and I think people, you know, if you present it in a nonjudgmental way, will tell you, ‘I’m smoking a half a pack, I’m smoking a pack.’ I just wish we could go at it more from an angle of trying to figure out how to help people with their stress during pregnancy because I think people want to do right by their kids and I think people want to stop smoking or cut down.” (Nurse)