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Postgraduate Course Feedback. Smokers with chronic illness: a qualitative analysis of barriers, motivation to quit and tailored interventions for smoking cessation in smokers with and without COPD - PowerPoint PPT Presentation

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  • Postgraduate Course FeedbackSmokers with chronic illness: a qualitative analysis of barriers, motivation to quit and tailored interventions for smoking cessation in smokers with and without COPD

    Dr Camille Alexis-Garsee, Martha Burton, Prof. Olga van den Akker - Middlesex University Dr Hazel Gilbert University College London The study was funded by the IPCRG, UKRRF

  • OverviewWhy is smoking cessation important for smokers with COPD?How can tailored interventions help?This study Themes identifiedConclusion

  • IntroductionCOPD Chronic Obstructive Pulmonary DiseaseSmoking is a major cause of COPD as it accelerates the rate of decline in pulmonary function beyond that seen with aging (Burchfiel et al., 1995)Smokers with COPD are less likely to quit than those without impaired lung functionNICE guidanceReviews: combination of behavioural support and pharmacotherapy most effective for cessationWagena et al., (2004); van der Meer et al. (2003); Piresyfantouda et al. (2013); Tnnesen, (2013).

  • IntroductionTailored interventions are based on information collected from each person by an assessment questionnaire, the data is then entered into a computer programme in order to generate unique personalised reports for the individual

    Previous research has found some success with this type of intervention (Noar et al, 2007; Lancaster & Stead, 2005)

    The computer tailored intervention evaluated in this study, has significantly increased 7-day point abstinence rates and 1 month prolonged abstinence rates at the six month follow-up (Sutton & Gilbert, 2007)

  • The AimTo understand COPD smokers experiences when trying to quit and to obtain participants perception of the computer-tailored feedback developed for smoking cessation

    *Slide *

  • MethodSix GP practices representing small (n10,000) list sizes in North London

    360 smokers 35-65, with and without mild to moderate COPD were identified using the practice computer systems

    ParticipantsOf those invited, 56 opted out of the study40 smokers completed and returned questionnaires (response 12.2%) and 26 agreed to be interviewed and completed the study

    *Slide *Design: Qualitative study with smokers recruited from GP Practices in North London

  • MethodMeasuresQuestionnaire: intention, motivation, dependence, self-efficacy, advantages and disadvantages of quitting, MRC Dyspnoea ScaleInterviews26 interviews all received 30 for 90 minute interview, plus additional 10 for travel; Semi-structured interview guideData Analysis Interviews entered into Nvivo 8. Thematic analysis conducted (Braun and Clarke, 2006)

    *Slide *

  • Results*Slide *

  • Results Thematic Map*Slide *

  • Results Thematic Map*Slide *

  • ResultsTheme 1: Barriers and Motivation to Quit Use of Cigarettes

    [Smoke] forty to sixty a day, now. I was ten, I was, yeah, but because of the problem I got now [COPD] its, its stress, and you know thinking about like, there is no cure for what I got, you know. Like that stresses me a lot and instead of stopping yeah, I keep on smoking, you know. [P13: M, 43, COPD]

    *Slide *

  • Barriers and Motivation To Quit Health and IllnessMy lungs were messed up. And err I was told that in 2005 and she said youve got to stop smoking now, not in the future, now is your best chance. But I never noticed it was hurting me so much then I could still breathe and I thought, well I carried on. [P21: M, 55, COPD]

    *Slide *

  • Barriers and Motivation - Social Support Family and friendsBut the difficulty is that I live with a, a partner and its like erm its something we enjoy doing together and err if I, if Im , if Im determined to say no, no, Ive really go to stop doing this erm the other ones not of the same mind. [P5: M, 62, COPD]*Slide *

  • Barriers and Motivation - Social Support: Lack of guidance from GPNo, no, no, no, no. Hes not. He [GP] just tell you like you got that and err the reason err you have to stop smoking, there is nurse over there, you can go and find, find your way and erm look for help thats it. You know what I mean? So he just like make you more upset, angry. [P13: M, 43, COPD]*Slide *

  • Barriers and Motivation Denial, Fear and ExcusesIt hurts, it hurts a little bit because I know at the end of the day even if I give up smoking I know theres a possibility Im still going to end up on oxygen, you know I do know that. [P9: F, 54, COPD]thats err and thats whats making me now think, I, I, I really need to stop. But then Im, but Im also scared of stopping. Because even if I still, still stop smoking whos to say that I wont get cancer? Whos to say that I wont get any of these things once I do stop smoking? [P22: F, 41, COPD]

    *Slide *

  • Barriers and Motivation Denial, Fear and Excuses...because my mother smokes. And she smokes, my mother is 80 and she smoked probably for 60 years. And theres nothing wrong with her health so this is another reason. [P1: F, 47, No COPD]

    *Slide *

  • Theme 2: A New Experience Positive Impact Someones interested in me!Because its the first time that anybody has ever done anything like, that has actually been tailored to my needs. It makes sense like. Its, to me its like somebodys actually, actually taken a personal interest in me, you know, and what is best for me like. And thats the first time Ive ever had anything like that. [P28: M, 55, No COPD].

    *Slide *

  • A New Experience: More relevant advice This is something designated to me. (Flips pages) And erm, and I think its a, its a marvellous idea, better than, better than just going to see the practice nurse and her, her saying you know oh well try, well try you with these patches and that. [P11: M, 64, No COPD]

    *Slide *

  • Positive impact prompting behaviour changeYeah, it offers you, gives good advice there. Yes, I, Im reading it and listen to the advice and err, yeah I stop from 60 a day I drop down to 25. Its good no? [P35: M, 66, COPD]I dont think its something I could just do on my own, I think I would need someone, go to these no smoking clinics and get support from them. I believe I need that sort of help. [P19, F, 52, No COPD]

    *Slide *

  • A New Experience Strategies to improve to encourage cessation: dont send in isolation!Yeah and you can actually get feedback, although it, maybe having them both, maybe having the leaflet, reading through it and then being able to like you know if theres any questions there that I need answered be nice to have that answer yeah. [P22: F, 41, COPD]

    *Slide *

  • A New Experience Strategies to improve to encourage cessation: positive reinforcing information after failing to quitId just say dont leave a big gap, Id emphasise the fact that, that people once theyve had a failed attempt they tend to leave it for ages, they go oh I cant do it, Im never going to be able to stop. And its not until 6 months later or a year later or 5 years later they wake up again and go oh I better have another attempt. But, you should just, just try and encourage them to, even if you have failed put them down again, 2 weeks later, or 3 days later or even 3 hours later have another go. [P21: M, 55, COPD]*Slide *

  • ConclusionThough many would like to quit smoking, they find it difficult to do so and a stand-alone computer-tailored intervention may not be the best way forwardMay prompt some to think about quitting and initiate behaviour change but would be better to combine with more intensive support (Tnnesen, 2013)Highlights importance of support mechanisms for smokers wanting to quit

    *Slide *

  • ConclusionLimitations: views may not be representative; only small number formal COPD diagnosis recruitedRecommendations: GPs role; encourage smokers to quit at every opportunity; spirometry in those at risk; want a more tailored and personal approach from health professionals; further research on effects of different types of interventions for COPD smokers

    *Slide *

  • ReferencesBaron KP. To smoke or not to smoke: predictors of smoking behaviour in people with head and neck cancer and chronic obstructive pulmonary disease. Diss Abs Inter: Sec B: The Sc and Engin 2003; 64:954.Kerr S, Watson H, Tolson D, Lough M, Brown M. Smoking after the age of 65 years: a qualitative exploration of older current and former smokers' views on smoking, and smoking cessation resources and services. Health and Social Care in the Comm 2006; 14(6):572-582.Noar SM, Benac CN, Harris M. Does Tailoring Matter? A Meta-Analytic Review of Tailored Print Health Behavior Change Interventions. Psychol Bulletin 2007; 133(4):673-693.Piresyfantouda, R, Absalom G, Clemens F. Smoking Cessation Interventions for Chronic Obstructive Pulmonary Disease A Review of the Literature. Respir Care 2013; DOI:10.4187/respcare.01923Shahab L, Jarvis MJ, Britton J, West R. Prevalence, diagnosis and relation to tobacco dependence of chronic obstructive pulmonary disease in a nationally representative population sample. Thorax 2006; 61:1043-1047.

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  • ReferencesSutton S, Gilbert H. Effectiveness of individually tailored smoking cessation advice letters as an adjunct to telephone counseling and generic self-help materials: a randomised controlled trial. Addiction 2007; 102(6):994-1000.Tonnesen P, Carrozzi L, Fagerstrom KO et al. Smoking cessation in pateints with respiratory diseases: a high priority, integral component of therapy. Eu Respir J 2007; 29(2):390-417.van der Meer RM, Wagena E, Ostelo RWJG, Jacobs AJE, van Schayck OP. Smoking cessation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2001(updated 2003); 1:1-28.Wagena EJ, van der Meer RM