The Attitudes of Pulmonologists Regarding Smoking Behavior of Their Patients with Advanced COPD: A Qualitative Research

BACKGROUND: Patients with diseases linked with smoking, such as COPD, report a health-related stigma on their smoking behavior, which is related to a poorer quality of life and psychological distress. According to patients with COPD, health-care professionals sometimes reinforce the sense of stigma. However, little is known about the physicians’ attitudes on this topic towards the patient with COPD. PURPOSE: To explore attitudes of pulmonologists regarding the smoking behavior of their patients with COPD and if (and to what extent) a stigma is present in their attitudes towards their smoking patients. PATIENTS AND METHODS: Eighteen pulmonologists were interviewed using a semi-structured guide with prespecified topics. The interview transcripts were coded using Atlas.ti. Analysis of data from these interviews was performed using conventional content analysis. RESULTS: We identified three themes: attitudes towards smoking in general, the interaction between patient and physician, and smoking cessation. All participants said patients are not fully responsible for their smoking behavior. Contrarily, smoking was also seen as a free choice by most physicians. Moreover, smoking cessation was mostly seen as the responsibility of the patient. Feelings of powerlessness, frustration and compassion were reported in the guidance of patients with COPD. CONCLUSION: The results of this study show an ambivalent attitude of pulmonologists regarding the smoking behavior of their patients with COPD. The outcomes of this study can form a base for further research and can be used as insights for interventions that aim to raise awareness of physicians’ own attitudes and increase the quality of physician–patient communication.