Abstract

Smoking cessation is the only effective intervention to slow down the accelerated decline in lung function in smokers with chronic obstructive pulmonary disease. Nevertheless, physicians often do not routinely provide evidence-based smoking cessation treatment to their patients. To understand underlying reasons, we explored how physicians engage in smoking cessation treatment in their chronic obstructive pulmonary disease patients. In total, 21 focus group discussions were held with general practitioners and pulmonologists in seven different countries in Europe and Asia. We generated three themes, whereby some of the issues concerned smokers in general: first, ‘physicians’ frustration with chronic obstructive pulmonary disease patients who smoke’. These frustrations interfered with the provision of evidence-based treatment and could result in this group of patients being treated unequally. Second: ‘physicians’ limited knowledge of, and negative beliefs about, smoking cessation treatment’. This hindered treating smokers effectively. Third: ‘healthcare organisational factors that influence the use of smoking cessation treatments’. Money and time issues, as well as the failure to regard smoking as a disease, influenced how physicians engaged in smoking cessation treatment. Our results indicate that there is a number of barriers to the provision of effective smoking cessation treatment in patients with chronic obstructive pulmonary disease and smokers in general. Introducing an informative smoking cessation programme, including communication skills and ethical issues, in the vocational and postgraduate medical training may help to address these barriers. This is important in order to increase engagement with smoking cessation treatment and to improve quality of chronic obstructive pulmonary disease care.

Highlights

  • Chronic obstructive pulmonary disease (COPD) is a major public and individual health problem

  • Physicians’ limited knowledge of, and negative beliefs about, Physicians seemed to feel responsible for motivating patients to smoking cessation treatment quit smoking

  • In the focus group discussions (FGDs), the physicians mentioned patient-related, physician-related and healthcare organisational factors that hindered the routine provision of evidence-based smoking cessation treatment to patients with COPD

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Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a major public and individual health problem. By 2020, COPD will rank fifth worldwide in terms of burden of disease and third in terms of mortality.[1] Higher mortality rates and an accelerated decline in lung function are seen in patients with COPD who continue smoking.[1] Smoking cessation is the most important treatment for patients with COPD, as it is the only evidence-based intervention which has been proven to slow down the accelerated decline in lung function.[1]. This implies that many COPD patients still continue smoking even though quitting is their best treatment option

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