They don’t want it ramming down their throats. Learning from the perspectives of current and ex-smokers with smoking-related illness to improve communication in primary care: a qualitative study

Aim To enhance the effectiveness of smoking cessation communication in primary care by gaining insight into the motivations and perceptions of smokers and ex-smokers with chronic obstructive pulmonary disease (COPD). Background Stopping smoking is the single most important action smokers with COPD can take to improve their health. A Cochrane systematic review identified the need for more research into effective smoking cessation approaches for patients with COPD. Methods A qualitative study using semi-structured interviews with COPD patients in South Yorkshire undertaken as part of the formal evaluation of an innovative rehabilitation program (‘Breathing Space’). Participants Patients with COPD (current and ex-smokers) who were invited to attend a program of rehabilitation or support at Breathing Space Findings Current smokers tended to deny the contribution of smoking to their COPD. A low level of acknowledgement of the association between smoking and COPD was demonstrated, particularly by long-term COPD patients. Participants described health and money as the most important motivators in stopping smoking. An overly directive or ritualistic approach by health professionals was perceived as counter-productive. Participants perceived that smokers were deterred from accessing care through embarrassment and fear of discrimination. Conclusions A direct but supportive approach is likely to be effective when discussing the association between smoking and COPD with patients. Assisting smokers to acknowledge the objective dangers and the personal risk of smoking is indicated. Approaching smoking as an objective condition to be solved as a joint enterprise between patient and clinician can reduce message avoidance while inducing a sense of personal control, thereby increasing successful quitting.