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      Barriers and facilitators to smoking cessation in a cancer context: A qualitative study of patient, family and professional views

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          Abstract

          Background

          Continued smoking after cancer adversely affects quality of life and survival, but one fifth of cancer survivors still smoke. Despite its demands, cancer presents an opportunity for positive behaviour change. Smoking often occurs in social groups, therefore interventions which target families and individuals may be more successful. This qualitative study explored patients, family members and health professionals’ views and experiences of smoking and smoking cessation after cancer, in order to inform future interventions.

          Methods

          In-depth qualitative interviews ( n = 67) with 29 patients, 14 family members and 24 health professionals. Data were analysed using the ‘Framework’ method.

          Results

          Few patients and family members had used National Health Service (NHS) smoking cessation services and more than half still smoked. Most recalled little ‘smoking-related’ discussion with clinicians but were receptive to talking openly. Clinicians revealed several barriers to discussion. Participants’ continued smoking was explained by the stress of diagnosis; desire to maintain personal control; and lack of connection between smoking, cancer and health.

          Conclusions

          A range of barriers to smoking cessation exist for patients and family members. These are insufficiently assessed and considered by clinicians. Interventions must be more effectively integrated into routine practice.

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          Most cited references 47

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          Tobacco smoking and cancer: a meta-analysis.

          We conducted a systematic meta-analysis of observational studies on cigarette smoking and cancer from 1961 to 2003. The aim was to quantify the risk for 13 cancer sites, recognized to be related to tobacco smoking by the International Agency for Research on Cancer (IARC), and to analyze the risk variation for each site in a systematic manner. We extracted data from 254 reports published between 1961 and 2003 (177 case-control studies, 75 cohorts and 2 nested case-control studies) included in the 2004 IARC Monograph on Tobacco Smoke and Involuntary Smoking. The analyses were carried out on 216 studies with reported estimates for 'current' and/or 'former' smokers. We performed sensitivity analysis, and looked for publication and other types of bias. Lung (RR = 8.96; 95% CI: 6.73-12.11), laryngeal (RR = 6.98; 95% CI: 3.14-15.52) and pharyngeal (RR = 6.76; 95% CI: 2.86-15.98) cancers presented the highest relative risks (RRs) for current smokers, followed by upper digestive tract (RR = 3.57; 95% CI: 2.63-4.84) and oral (RR = 3.43; 95% CI: 2.37-4.94) cancers. As expected, pooled RRs for respiratory cancers were greater than the pooled estimates for other sites. The analysis of heterogeneity showed that study type, gender and adjustment for confounding factors significantly influence the RRs estimates and the reliability of the studies. Copyright 2007 Wiley-Liss, Inc.
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            Interventions with family caregivers of cancer patients: meta-analysis of randomized trials.

            Family caregivers of cancer patients receive little preparation, information, or support to perform their caregiving role. However, their psychosocial needs must be addressed so they can maintain their own health and provide the best possible care to the patient. The purpose of this article is to analyze the types of interventions offered to family caregivers of cancer patients, and to determine the effect of these interventions on various caregiver outcomes. Meta-analysis was used to analyze data obtained from 29 randomized clinical trials published from 1983 through March 2009. Three types of interventions were offered to caregivers: psychoeducational, skills training, and therapeutic counseling. Most interventions were delivered jointly to patients and caregivers, but they varied considerably with regard to dose and duration. The majority of caregivers were female (64%) and Caucasian (84%), and ranged in age from 18 to 92 years (mean age, 55 years). Meta-analysis indicated that although these interventions had small to medium effects, they significantly reduced caregiver burden, improved caregivers' ability to cope, increased their self-efficacy, and improved aspects of their quality of life. Various intervention characteristics were also examined as potential moderators. Clinicians need to deliver research-tested interventions to help caregivers and patients cope effectively and maintain their quality of life. Copyright 2010 American Cancer Society, Inc.
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              The common-sense model of self-regulation of health and illness

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                Author and article information

                Contributors
                mary.wells@stir.ac.uk
                p.e.aitchison@stir.ac.uk
                fiona.harris1@stir.ac.uk
                go10@st-andrews.ac.uk
                andrew.radley@nhs.net
                linda.bauld@stir.ac.uk
                Vikki.Entwistle@abdn.ac.uk
                ajm28@st-andrews.ac.uk
                s.j.haw@stir.ac.uk
                b.culbard@yahoo.co.uk
                b.williams@napier.ac.uk
                Journal
                BMC Cancer
                BMC Cancer
                BMC Cancer
                BioMed Central (London )
                1471-2407
                19 May 2017
                19 May 2017
                2017
                : 17
                Affiliations
                [1 ]ISNI 0000 0001 2248 4331, GRID grid.11918.30, NMAHP Research Unit, , University of Stirling, ; Scion House, Stirling, FK9 4HN UK
                [2 ]ISNI 0000 0001 0721 1626, GRID grid.11914.3c, , School of Medicine, University of St Andrews, ; St Andrews, KY16 9TF UK
                [3 ]GRID grid.415350.6, NHS Tayside, Public Health Directorate, , Kings Cross Hospital, ; Dundee, DD3 8EA UK
                [4 ]ISNI 0000 0001 2248 4331, GRID grid.11918.30, Insitute of Social Marketing, Faculty of Health Sciences and Sport, , University of Stirling, ; Stirling, FK9 4LA UK
                [5 ]ISNI 0000 0004 1936 7291, GRID grid.7107.1, Health Services Research Unit, , University of Aberdeen, ; Aberdeen, AB25 2ZD UK
                [6 ]ISNI 0000 0001 2248 4331, GRID grid.11918.30, Faculty of Health Sciences and Sport, , University of Stirling, ; Stirling, FK9 4LA UK
                [7 ]ISNI 000000012348339X, GRID grid.20409.3f, , School of Health and Social Care, Edinburgh Napier University, ; 9 Sighthill Court, Edinburgh, EH11 4BN UK
                Article
                3344
                10.1186/s12885-017-3344-z
                5438552
                28526000
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000589, Chief Scientist Office;
                Award ID: CZH/4/807
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

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