How cardiac patients describe the role of their doctors in smoking cessation: a qualitative study
Emily C. Hansen A B D and Mark R. Nelson B C
+ Author Affiliations
- Author Affiliations
A School of Sociology and Social Work, University of Tasmania, Private Bag 33, Hobart, Tas. 7001, Australia.
B Menzies Research Institute Tasmania, University of Tasmania, Private Bag 33, Hobart, Tas. 7001, Australia.
C Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Vic. 3800, Australia.
D Corresponding author. Email: Emily.Hansen@utas.edu.au
Australian Journal of Primary Health 17(3) 268-273 https://doi.org/10.1071/PY10082
Submitted: 29 October 2010 Accepted: 18 February 2011 Published: 5 September 2011
Abstract
This article reports a qualitative study investigating patients’ experiences of ongoing smoking or smoking cessation after hospitalisation for an acute coronary syndrome (myocardial infarction or unstable angina) and describes how study participants spoke about the role of their doctors in smoking cessation. We invited individuals who had been admitted to an Australian public hospital in 2005 with a discharge diagnosis of an acute cardiac syndrome and who were smokers at the time of their hospitalisation to participate. Participants underwent a semi-structured interview and ongoing smokers also completed a ‘stages of change’ questionnaire. In total, 35 participants were interviewed, including 14 who were no longer smoking at least 12 months after their admission and 21 who were. Findings gave insight into the ways that cardiac patients perceive smoking cessation advice from their doctors, the perceived stigma of smoking and how lay understandings about smoking and smoking cessation emphasise the role of choice and individual responsibility. Our findings also indicate considerable scope for GPs and other doctors to offer better smoking cessation support to patients with established cardiovascular disease, particularly after a period of hospitalisation when the majority are highly motivated to stop smoking.
Additional keywords: cardiovascular disease, qualitative research, secondary prevention.
References
Bancroft A, Wiltshire S, Parry O, Amos A (2003) ‘It’s like an addiction first thing … afterwards it’s like a habit’: daily smoking behaviour among people living in areas of deprivation. Social Science & Medicine 56, 1261–1267.| ‘It’s like an addiction first thing … afterwards it’s like a habit’: daily smoking behaviour among people living in areas of deprivation.Crossref | GoogleScholarGoogle Scholar |
Bjerrum L, Hamm L, Toft B, Munck A, Kragstrup J (2002) Do general practitioner and patient agree about the risk factors for ischaemic heart disease? Scandinavian Journal of Primary Health Care 20, 16–21.
| Do general practitioner and patient agree about the risk factors for ischaemic heart disease?Crossref | GoogleScholarGoogle Scholar |
Butler C, Pill R, Stott N (1998) Qualitative study of patients’ perceptions of doctors’ advice to quit smoking: implications for opportunistic health promotion. British Medical Journal 313, 1878–1881.
Chapman S, MacKenzie R (2010) The global research neglect of unassisted smoking cessation: causes and consequences PLoS Medicine 7, e1000216
| The global research neglect of unassisted smoking cessation: causes and consequencesCrossref | GoogleScholarGoogle Scholar |
Charmaz K (2002) Qualitative interviewing and grounded theory analysis. In ‘Handbook of interview research: context and method.’ (Eds J Gubrium, J Holstein) pp. 675–694. (Sage Publications: Thousand Oaks, CA)
Coleman T, Wilson A (1999) Factors associated with the provision of anti-smoking advice by general practitioners The British Journal of General Practice 49, 557–558.
Critchley JA, Capewell S (2003) Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review Journal of the American Medical Association 290, 86–97.
| Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic reviewCrossref | GoogleScholarGoogle Scholar |
Cupertino PA, Richter KP, Cox LS, Nazier N, Greiner AK, Ahluwalia JS, Ellerbeck EF (2008) Smoking cessation pharmacotherapy preferences in rural primary care. Nicotine & Tobacco Research 10, 301–307.
| Smoking cessation pharmacotherapy preferences in rural primary care.Crossref | GoogleScholarGoogle Scholar |
Davison C, Frankel S, Smith GD (1992) The limits of lifestyle: re-assessing ‘fatalism’ in the popular culture of illness prevention. Social Science & Medicine 34, 675–685.
| The limits of lifestyle: re-assessing ‘fatalism’ in the popular culture of illness prevention.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK383ksFCjtw%3D%3D&md5=fc879e51e4e1e81152fea7a4ad8688d2CAS |
Daykin N (1993) Young women and smoking: towards a sociological account. Health Promotion International 8, 95–102.
| Young women and smoking: towards a sociological account.Crossref | GoogleScholarGoogle Scholar |
DiClemente C, Prochaska J, Fairhurst S, Velicer W, Velasquez M, Rossi J (1991) The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology 59, 295–304.
| The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M3jtFGksg%3D%3D&md5=c69417a55ed54f38eccec5a38066c9c5CAS |
Edwards D, Freeman T, Litt J, Roche AM (2006) GP’s confidence in and barriers to implementing smoking cessation activities: compared to dentists, dental hygienists and pharmacists. Australian Journal of Primary Health 12, 117–125.
| GP’s confidence in and barriers to implementing smoking cessation activities: compared to dentists, dental hygienists and pharmacists.Crossref | GoogleScholarGoogle Scholar |
Finlay L (2002) ‘Outing’ the researcher: the provenance, process and practice of reflexivity. Qualitative Health Research 12, 531–545.
| ‘Outing’ the researcher: the provenance, process and practice of reflexivity.Crossref | GoogleScholarGoogle Scholar |
Frankel S, Davison C, Smith GD (1991) Lay epidemiology and the rationality of responses to health education. The British Journal of General Practice 41, 428–430.
French DP, Maissi E, Marteau TM (2005) The purpose of attributing cause: beliefs about the causes of myocardial infarction. Social Science & Medicine 60, 1411–1421.
| The purpose of attributing cause: beliefs about the causes of myocardial infarction.Crossref | GoogleScholarGoogle Scholar |
Gerber Y, Rosen LJ, Goldbourt U, Benyamini Y, Drory Y (2009) Smoking status and long-term survival after first acute myocardial infarction. Journal of the American College of Cardiology 54, 2382–2387.
| Smoking status and long-term survival after first acute myocardial infarction.Crossref | GoogleScholarGoogle Scholar |
Guba E, Lincoln Y (1989) ‘Fourth generation evaluation.’ (Sage Publications: Thousand Oaks, CA)
Hansen EC, Walters J, Wood Baker R (2007) Explaining chronic obstructive pulmonary disease (COPD): perceptions of the role played by smoking. Sociology of Health & Illness 29, 730–749.
| Explaining chronic obstructive pulmonary disease (COPD): perceptions of the role played by smoking.Crossref | GoogleScholarGoogle Scholar |
Lancaster T, Stead LF (2004) Physician advice for smoking cessation. In ‘The Chochrane database of systematic reviews (4).’ Art No. CD000164.pub000162.
Lawson PJ, Flocke SA (2009) Teachable moments for health behaviour change: a concept analysis. Patient Education and Counseling 76, 25–30.
| Teachable moments for health behaviour change: a concept analysis.Crossref | GoogleScholarGoogle Scholar |
Link BG, Phelan JC (2001) Conceptualizing stigma. Annual Review of Sociology 27, 363–385.
| Conceptualizing stigma.Crossref | GoogleScholarGoogle Scholar |
McKenna K, Higgins H (1997) Factors influencing smoking cessation in patients with coronary artery disease. Patient Education and Counseling 32, 197–205.
| Factors influencing smoking cessation in patients with coronary artery disease.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c%2FosFGmuw%3D%3D&md5=b82f98652761bbaeb5462f5879a1aec8CAS |
NICE (2006) ‘Brief interventions and referral for smoking cessation in primary care and other settings.’ (NICE: London)
Parry O, Fowkes FGR, Thompson C (2001a) Accounts of quitting among older ex-smokers with smoking-related disease. Journal of Health Psychology 6, 481–493.
| Accounts of quitting among older ex-smokers with smoking-related disease.Crossref | GoogleScholarGoogle Scholar |
Parry O, Thompson C, Fowkes FGR (2001b) Dependent behaviours and beliefs: a qualitative study of older long-term smokers with arterial disease. Addiction (Abingdon, England) 96, 1337–1347.
| Dependent behaviours and beliefs: a qualitative study of older long-term smokers with arterial disease.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MrmsFKisw%3D%3D&md5=1f181a31d8dc8cb36668e8d23a3d654dCAS |
Popay J, Bennett S, Thomas C, Williams G, Gatrell A, Bostock L (2003) Beyond ‘beer, fags, eggs and chips’? Exploring lay understandings of social inequalities in health. Sociology of Health & Illness 25, 1–23.
| Beyond ‘beer, fags, eggs and chips’? Exploring lay understandings of social inequalities in health.Crossref | GoogleScholarGoogle Scholar |
Quist-Paulsen P, Gallefoss F (2003) Randomised controlled trial of smoking cessation after admission for coronary heart disease. British Medical Journal 327, 1254–1257.
| Randomised controlled trial of smoking cessation after admission for coronary heart disease.Crossref | GoogleScholarGoogle Scholar |
Rea TD, Heckbert SR, Kaplan RC, Smith NL, Lemaitre RN, Psaty BM (2002) Smoking status and risk for recurrent coronary events after myocardial infarction. Annals of Internal Medicine 137, 494–500.
Royal Australian College of General Practitioners (2004) ‘Smoking cessation guidelines for Australian general practice.’ (Royal Australian College of General Practitioners: Sydney)
Shah A, Pfeffer MA, Hartley LH, Moyè LA, Gersh BJ, Rutherford JD, Lamas GA, Rouleau JL, Braunwald E, Solomon SD (2010) Risk of all-cause mortality, recurrent myocardial infarction, and heart failure hospitalisation associated with smoking status, following myocardial infarction with left ventricular dysfunction. The American Journal of Cardiology 106, 911–916.
| Risk of all-cause mortality, recurrent myocardial infarction, and heart failure hospitalisation associated with smoking status, following myocardial infarction with left ventricular dysfunction.Crossref | GoogleScholarGoogle Scholar |
Smith B, Sullivan E, Bauman A, Powel-Davies G, Mitchell J (1999) Lay beliefs about the preventability of major health conditions. Health Education Research 14, 315–325.
| Lay beliefs about the preventability of major health conditions.Crossref | GoogleScholarGoogle Scholar |
Stead LF, Bergson G, Lancaster T (2008) Physician advice for smoking cessation. Chochrane Database of Sytematic Reviews CD000165
| Physician advice for smoking cessation.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1c3msVWmsw%3D%3D&md5=2520fbe5ae06b4a49bd543e458bdfd98CAS |
Stott N, Pill R (1990) Advise yes, dictate no: patient’s views on health promotion in the consultation. Family Practice 7, 125–131.
| Advise yes, dictate no: patient’s views on health promotion in the consultation.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3czhs1elug%3D%3D&md5=374994bf70ab7c59c295cf98a54df9c1CAS |
Wiles R (1998) Patients perceptions of their heart attack and recovery: the influence of epidemiological ‘evidence’ and personal experience. Social Science & Medicine 46, 1477–1486.
| Patients perceptions of their heart attack and recovery: the influence of epidemiological ‘evidence’ and personal experience.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1czivVGitg%3D%3D&md5=d2aa890df91f5800b28cda0be3b27d6cCAS |
Williams G (1992) Good days, bad days – the self in chronic illness and time – Charmaz, K. The Sociological Review 40, 797–799.
Zhu S, Melcer T, Sun J, Rosbrook B, Pierce J (2000) Smoking cessation with and without assistance: a population-based analysis. American Journal of Preventive Medicine 18, 305–311.
| Smoking cessation with and without assistance: a population-based analysis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c3ltVOgtQ%3D%3D&md5=4aa23b6589e98c5f64e96ce8586e39b8CAS |
Zwar N, Richmond R, Borland R, Stillman S, Cunningham M, Litt J (2004) ‘Smoking cessation guidelines for Australian general practice.’ (Commonwealth Department of Health and Ageing: Canberra)
