Guilt, shame and stigma – how patients who smoke experience healthcare

Guilt, shame and stigma – how patients who smoke experience healthcare

Guilt, shame and stigma – how patients who smoke experience healthcare

A new study from Monash University has looked at how current and ex-smokers living with chronic obstructive pulmonary disease (COPD), other chronic illnesses, or those with no chronic conditions, experience care from their general practitioner (GP) and in particular if they perceived their smoking status impacted their quality of care.

The study, from the Monash School of Public Health and Preventive Medicine and Department of General Practice, was led by a PhD student, Sanduni Madawala under the supervision of Dr Chris Barton, and incorporated an analysis of 168 participants with self-reported chronic obstructive pulmonary disease (COPD), emphysema and chronic bronchitis; 224 people with other chronic illnesses (heart disease, stroke, diabetes and hypertension) and 173 participants reporting no chronic conditions.

Participants completed an online survey about their experience of care from GPs in the past 12 months with respondents self-reporting doctor-diagnosed chronic illnesses with results showing that adults with COPD reported significantly higher anticipated stigma scores – compared to those with other chronic conditions and no chronic conditions- and this was strongly related to delayed or avoidance in seeking help from a GP when needed. Importantly this relationship remained irrespective of current smoking status.

The findings are now published in the SAGE journal Chronic Illness.

Smoking is closely associated with respiratory disease and smoking cessation is the single most important treatment to slow the progression of the disease. Despite this, as many as 25 per cent of Australian COPD patients continue to smoke after diagnosis placing this group at particular risk for adverse outcomes and continued decline in lung function.

Previous studies have indicated that adults who currently smoke may be particularly vulnerable to poor patient experiences in the primary care setting, particularly those with lower socio-economic status and those living with chronic, smoking-related illnesses. “Current smokers may be reluctant to access services due to embarrassment or fear of being judged and perceive themselves to be receiving a reduced level of service,” said Ms Madawala.

She adds: “Feelings of being judged, feelings of guilt and shame can lead patients to hide their smoking history or their diagnosis of a respiratory illness while others may not feel worthy of treatment.”

Importantly, smokers who rate their patient experience of care and trust in their GP as low may be more resistant to messages to quit smoking while, in contrast, where patients report positive encounters with health professionals they show a willingness to further engage with health professionals in smoking cessation support.

Researchers used data from a nationwide survey of smokers and ex-smokers in Australia in 2019 and 2020, before COVID-19 restrictions were introduced in Australia. The secondary analysis was conducted on a subset of 585 participants, aged 35 years or older who had seen a GP in the previous 12 months and were either current smokers or ex-smoker who had quit smoking within the last five years surveyed.

Anticipated stigma and the experience of their care were assessed amongst patients who had visited a GP in the past 12 months. The researchers investigated the impact of smoking status on perceived care experience between survey respondents with COPD and those with other or no chronic illnesses.

The study found that about smoking was significantly different across the chronic illness groups with respondents living with a diagnosis of COPD compared with guilt living with other chronic illnesses and feeling more shame about their smoking when talking to a healthcare provider.

“COPD patients were likely to anticipate experiencing stigma in the GP setting, irrespective of current smoking status, and this anticipation of stigma was a strong predictor of delayed or avoided health care access when needed,” said Ms Madawala.

These findings indicate the importance of investigating issues of access and how stigma is experienced amongst this group in primary care settings to better meet the needs of patients with smoking-related illnesses and provide patients with a better experience in primary care.

Read the full paper in the SAGE journal Chronic Illness titled: The impact of smoking status on anticipated stigma and experience of care among smokers and ex-smokers with chronic illness in general practice.DOI: 10.1177/17423953221101337

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