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Arthritis Care Res (Hoboken). 2019 Feb 15. doi: 10.1002/acr.23858. [Epub ahead of print]

Patient Perspectives on Smoking Cessation and Interventions in Rheumatology Clinics.

Author information

1
University of Wisconsin, School of Medicine and Public Health (UW-SMPH), Madison, WI, United States.
2
Medical College of Wisconsin, Rheumatology, Milwaukee, WI, United States.
3
University of Iowa, Carver College of Medicine, Immunology, Iowa City, IA, United States.
4
UW School of Nursing, Madison, WI, United States.
5
UW-SMPH Department of Family Medicine and Community Health, Madison, WI, United States.
6
UW College of Engineering, Madison, WI, United States.
7
UWSMPH, Center for Tobacco Research and Intervention, Madison, WI, United States.
8
Community Engagement Specialist, Sadusky Consulting, Madison, WI, United States.
9
UW-SMPH Department of Pediatrics, Madison, WI, United States.
10
UW School of Pharmacy, Madison, WI, United States.
11
UW-SMPH Department of Medicine, Rheumatology, Madison, WI, United States.

Abstract

OBJECTIVE:

Although smoking is a risk factor for cardiovascular and rheumatic disease severity, only 10% of rheumatology visits document cessation counseling. After implementing a rheumatology clinic protocol that increased tobacco quitline referrals 20-fold, current objectives were to 1) examine patients' barriers and facilitators to smoking cessation based on prior rheumatology experiences, 2) solicit reactions to the new cessation protocol, and 3) identify patient-centered outcomes or "signs of cessation progress" following improved care.

METHODS:

We recruited 19 patients who smoke-12 with rheumatoid arthritis (RA) and 7 with systemic lupus erythematosus (SLE)-to one of three semi-structured focus groups. Transcripts were analyzed using thematic analysis to classify barriers, facilitators, and signs of cessation progress.

RESULTS:

Participant-reported barriers and facilitators to cessation involved psychological, health, and social and economic factors, and healthcare messaging, and resources. Commonly discussed barriers included viewing smoking as "a crutch" amid rheumatic disease, rarely receiving cessation counseling in rheumatology, and very limited awareness that smoking can worsen rheumatic diseases or reduce efficacy of some rheumatology medications. Participants endorsed our cessation protocol with rheumatology-specific education and accessible resources like the quitline. Beyond quitting, participants valued knowing why and how to quit as signs of progress outcomes.

CONCLUSION:

Focus groups identified themes and categories of patient and health system-level facilitators/barriers to smoking cessation. Two key outcomes of improving cessation care for patients with RA and SLE were knowing why and how to quit. Emphasizing rheumatologic health benefits and cessation resources are essential when designing and evaluating rheumatology smoking cessation interventions. This article is protected by copyright. All rights reserved.

PMID:
30768768
DOI:
10.1002/acr.23858

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