The old and familiar meets the new and unknown: Patient and clinician perceptions on e‐cigarettes for smoking reduction in UK general practice, a qualitative interview study

Albury, Charlotte, Barnes, Rebecca, Ferrey, Anne, Coleman, Tim, Gilbert, Hazel, Naughton, Felix, Aveyard, Paul and Begh, Rachna and MaSC Study Investigators (2022) The old and familiar meets the new and unknown: Patient and clinician perceptions on e‐cigarettes for smoking reduction in UK general practice, a qualitative interview study. Addiction, 117 (5). pp. 1427-1437. ISSN 0965-2140

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Background and Aims: Clinicians could promote e-cigarettes for harm reduction to people who smoke but cannot stop, but many clinicians feel uneasy doing so. In a randomized controlled trial (RCT), primary care clinicians offered free e-cigarettes and encouraged people with chronic diseases who were unwilling to stop smoking to switch to vaping. We interviewed clinicians and patients to understand how to adopt harm reduction in routine practice. Design: Qualitative analysis nested within an RCT, comprising thematic analysis of semi-structured interviews with primary care clinicians who delivered the trial intervention, and patients who took part. Setting: Primary care clinics in England. Participants/Cases: Twenty-one patients and 11 clinicians, purposively sampled from an RCT. Measurements: We qualitatively explored patients’ and clinicians’ experiences of: being offered/offering an e-cigarette, past and current perceptions about e-cigarettes and applying a harm reduction approach. Findings: Four themes captured clinicians’ and patients’ reported perspectives. These were: (1) concepts of safety/risk, with clinicians concerned about recommending a product with unknown long-term risks and patients preferring the known risks of cigarettes; (2) clinicians felt they were going out on a limb by offering these as though they were prescribing them, whereas patients did not share this view; (3) equating quitting with success, as both patients and clinicians conceptualized e-cigarettes as quitting aids; and (4) unchanged views, as clinicians reported that training did not change their existing views about e-cigarettes. These themes were united by the higher-order concept: ‘The old and familiar meets the new and unknown’, as a contradiction between this new approach and long-established methods underpinned these concerns. Conclusions: A qualitative analysis found barriers obstructing clinicians and patients from easily accepting e-cigarettes for harm reduction, rather than as aids to support smoking cessation: clinicians had difficulty reconciling harm reduction with their existing ethical models of practice, even following targeted training, and patients saw e-cigarettes as quitting aids.

Item Type: Article
Additional Information: Funding Information: The study is funded by a National Institute for Health Research (NIHR) Postdoctoral Fellowship awarded to R.B. (PDF‐2016‐09‐043) and an NIHR School for Primary Care Research project grant (project reference 333). The views expressed in this publication are those of the authors and not necessarily those of the NIHR, NHS, Health Education England or the Department of Health and Social Care. P.A. is funded by the NIHR Oxford Biomedical Research Centre and NIHR Oxford and Thames Valley Applied Research Collaboration. T.C. is a National Institute for Health Research (NIHR) Senior Investigator. We would like to thank all the patients and clinicians who took part in this study and the other investigators and trial management team on the MaSC trial. We would also like to thank Dr Paul Bateman, who collated quantitative patient demographic data from the MaSC trial.
Uncontrolled Keywords: e-cigarettes,family practice,harm reduction,primary care,qualitative interviews,smoking reduction,psychiatry and mental health,medicine (miscellaneous),sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2738
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health
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Depositing User: LivePure Connector
Date Deposited: 15 Dec 2021 09:30
Last Modified: 19 Oct 2023 03:12
DOI: 10.1111/add.15760

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