SOME smokers feel so stigmatised that they won’t visit their GP, even when they have the symptoms of lung cancer, a new Australian study has found.

The qualitative sub-study, which was published in Family Practice, featured interviews with a representative sample of 20 patients in Melbourne and Perth, who had participated in the larger CHEST Australia intervention trial.

The CHEST Australia trial aimed to recruit 550 patients at increased risk of lung cancer, and delivered an intervention aimed at promoting earlier presentation to primary health care. It was based on the CHEST trial in Scotland, which found preliminary evidence that the approach may alter consulting patterns in this population.

Trial participants were given a consultation with a primary care nurse where they discussed and implemented a self-help manual. They later received self-monitoring reminders to help improve their understanding of lung cancer symptoms and encourage them to seek help if required.

The qualitative interviews conducted after the end of the main study showed that people at high risk of lung cancer felt stigmatised about their smoking histories, and often have a general mistrust of doctors based on previous negative health care experiences.

Lead author Professor Jon Emery from the University of Melbourne told MJA InSight: “Even though GPs will bring up the smoking for good reason and try to get them to quit, it does have a perverse disincentive of potentially creating a barrier to help seeking when patients become symptomatic”.

Study participants spoke of feeling lectured by their doctor.

According to one participant: “I said, yes I smoke. I said, why are you shaking your finger at me? So I don’t like that. I got up and I walked out”.

Ideally, the smoking cessation message should be tailored to the personality of the patient, the study authors said.

Clinical Professor of General Practice at Deakin University, Professor Gerard Gill told MJA InSight: “We need to look at the effect that continuity of care and the doctor–patient relationship have on how people take up messages. It’s unfortunate that general practice research capability in Australia has been reduced to almost nothing because there’s no funding”.

Respiratory Physician from St John of God Midland Public and Private Hospitals Dr Dave Manners said that techniques that engage and enable smokers to make more positive health choices work much better than a lecture.

“A brief motivational discussion followed by an online referral to QUITLINE is a great option for time poor clinicians and may lead to cessation rates of 20%.”

Although the results from the larger study have not yet been analysed, the qualitative feedback was that a self-help manual gave patients a certain level of control as they could look at it on their own terms.

“Yeah, I could pick it up when I felt like reading it, it is not thrust upon you like when you are watching TV and I learn stuff …” one participant reported.

As people with higher risk of lung cancer often normalise their respiratory symptoms, the manual provided a list of symptoms to give patients a clearer idea of what to look out for and when to take action.

“We discussed a 3-week rule: if your symptoms haven’t changed over a 3-week period, then that’s a reason to consult your GP, except in the case of hemoptysis, where you need to go straight away,” Professor Emery explained.

The manual also highlighted the need to seek help early when symptoms are noticed.

“So I read about the guy who left it too late in the booklet, I thought, nah, that’s not going to be me …” one participant said.

Population screening for lung cancer is not currently recommended in Australia for reasons of cost, feasibility and the high rate of false-positive results. At only $1–2 a booklet, the authors hope that the CHEST intervention may be a cheaper option.

“This may be a lower cost option for a slightly larger group of people who we know are at increased risk of lung cancer. It may reduce delayed presentation, which may be another contributor in improving outcomes in lung cancer,” Professor Emery suggested.

The results of the larger study, including the health economics, will be available later in 2017.


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4 thoughts on “Smoker guilt and stigma delays help seeking

  1. Deb Downes says:

    Have to agree with the above comments.

    Firstly, one has to have faith in the health care system. Given the money that’s cut out of PH, why would anyone believe that if diagnosed they could get effective treatment?

    And yes, secondly, overseas PH Institutions recommend vaping as an alternative to smoking, and OUR AMA publish a submission which is not only full of drivel, but with laughable references to go with it. WHY would anyone have any faith in OUR public health system?

  2. C. B. says:

    How is it that cost is the primary concern from these medical groups? They speak about possibly achieving quit rates of 20% as if that would be some great feat but the reality is Australia is very narrow minded & far behind other countries when even talking about how to best help smokers. NRT’s have a failure rate upwards of 93%+ but AU Public Health/Tobacco Control refuses to look at any credible evidence that backs up ecigs as our best option to date. Tén years of reputable science from various sources.
    AU. AMA & other groups within the country continue to say ecigs have no evidence.
    The fact is the “establishment” refuses to read the data and decries vapers as “paid shills” because they cannot prove the nonsense they keep claiming like “plain packs work to help smokers quit”. Utter nonsense! The Aussie govt. should stop listening to alleged “self professed experts” & start talking to those who’s lives are at stake.

  3. Robert Innes says:

    Such a pity e-cigarettes are not accepted in Australia.

    A lady I know manages the stop smoking service for the city of Leicester in the UK. It was the first organisation of its king to recommend vaping as an alternative to smoking and is now the single most successful cessation service in the country. (And probably in the world) The success rate was highlighted at the Global Forum on Nicotine at Warsaw last month and her results are astounding… Year on year increases in use of ecigs (and smoking cessation) between 61% & 65%. Now compare this to the miserable 6% to 8% success rate of organisations who do not recommend vaping.

    A booklet to provide more information?

    How much more effective would it be if doctors actually looked into the mass of scientific literature and drew conclusions not based on junk science and bias?

  4. Joe Kosterich says:

    Another argument for legalising e-cigarettes as a harm reduction method which smokers can get without seeing a doctor!

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