The impact of smoking status on anticipated stigma and experience of care among smokers and ex-smokers with chronic illness in general practice

Abstract

Objectives To compare self-reported levels of ‘anticipated’ stigma and experience of care in general practice between current and ex-smokers living with COPD, other chronic illnesses, or those with no chronic conditions. Methods Participants completed an online survey, advertised through social media, about their experience of care from general practitioners (GPs) in the past 12 months. Respondents self-reported doctor-diagnosed chronic illnesses. Experience of care and anticipated stigma was assessed using validated questions. Multi-nominal regressions were used to determine independent effect of smoking status on anticipated stigma and other indicators of patient experience in primary care. Results Patients with COPD (n = 161) reported significantly higher anticipated stigma scores compared to those with other chronic conditions (n = 225) and this was strongly related to delayed or avoidance in seeking help from a GP when needed. This relationship remained irrespective of current smoking status. There was no difference between groups for relational components of experience of care. Discussion Primary care patients living with COPD reported worse experience of care across several domains and were more likely to anticipate experiencing stigma in the GP setting irrespective of their current smoking status compared to those with other chronic illnesses or no chronic illnesses.

Healthcare experiences of adults with COPD across community care settings: a meta-ethnography

“…It is also important to understand the experience of trust and the meaning trust has to the patient with COPD, and how smoking impacts upon the experience of trust [21].…”

“…Additional issues relating to suboptimal interactions with healthcare providers were impacted by fear of judgement and stigmatisation. Stigma is known to negatively impact engagement with health services [ 61 ] and is problematic among people with COPD, and in particular those who continue to smoke, due to feelings of unworthiness, guilt or shame of being unable to stop smoking [ 21 , 62 ]. The studies in this review tended to view access within a restricted scope, and we recommend that future research should explore a broader conceptualisation of access, from perception of need through to healthcare consequences [ 63 ].…”

“…patient satisfaction) rather than as part of a broader exploration of the patient's experience of care. It is also important to understand the experience of trust and the meaning trust has to the patient with COPD, and how smoking impacts upon the experience of trust [ 21 ].…”

“…People who smoke can be particularly vulnerable to poor patient experience in healthcare settings, particularly those with lower socioeconomic status [ 13 ] and those living with chronic, smoking-related illnesses [ 21 ]. This is particularly relevant in COPD as many people report feelings of guilt and shame about smoking and “self-inflicted” smoking-related disease [ 22 , 23 ], and this might lead to experiences of stigma in healthcare settings which exacerbate poor patient experience of care [ 21 ].…”

Healthcare experience of adults with COPD during the COVID-19 pandemic: a rapid review of international literature

“…Studies of the lived experiences of patients with COPD prior to the emergence of COVID-19 had highlighted important concerns about interactions with healthcare professionals and experience of care which may impact upon health outcomes. 4–10 Understanding experience of care from the perspective of patients is essential to provision of high-quality, evidence-based care that is patient centred. 11 12 Changes in healthcare provision introduced in response to the COVID-19 pandemic may have impacted the healthcare experience of adults with chronic respiratory illness.…”