Halding Anne-Grethe, Heggdal Kristin, Wahl Astrid
Faculty of Health Studies, Sogn og Fjordane University College, Førde, Norway.
Scand J Caring Sci. 2011 Mar;25(1):100-7. doi: 10.1111/j.1471-6712.2010.00796.x.
Chronic obstructive pulmonary disease (COPD) is a major health problem estimated to become the third leading cause of death and the fifth leading cause of disability by 2020. Tobacco control is the most effective protective intervention, and it serves as a key element in patient counselling. However, a focus on tobacco control may cause unintended and adverse effects to individuals who already suffer from the disease.
The current study aims to understand how patients with COPD experience daily life in a society with heavy emphasis on tobacco control.
The design was longitudinal and descriptive. The sample included thirteen men and five women with COPD, recruited from pulmonary rehabilitation units. Data were collected by means of qualitative interviews and analysed using qualitative content analysis with search for meanings.
The main theme was a feeling of being exiled in the world of the healthy, because of self-blame and society's stigmatisation of COPD as a self-inflicted disease. The participants experienced feelings of disgrace through subtle blame and a lack of support from their social network, health care encounters and larger society. This seemed to increase illness-related strain and a need for defensive actions.
A small convenience sample, local cultural influence, the study's wide scope and lack of health professionals' views must be considered.
This study illuminates the challenge of how to combine health advice on smoking cessation with nonblaming psycho-social support throughout the course of COPD. An awareness of the potential for stigma, the nature of nicotine dependence and broadened causal explanations for the disease may improve the ability of caregivers to address patient strain and its negative association with coping and well-being. Dilemmas in health communication concerning COPD patients' experience of stigma and negative emotional response should be further explored.
慢性阻塞性肺疾病（COPD）是一个重大的健康问题，预计到2020年将成为第三大致死原因和第五大致残原因。控烟是最有效的预防干预措施，也是患者咨询的关键要素。然而，关注控烟可能会对已经患有该疾病的个体产生意想不到的负面影响。
本研究旨在了解慢性阻塞性肺疾病患者在一个高度重视控烟的社会中如何体验日常生活。
采用纵向描述性设计。样本包括从肺康复病房招募的13名男性和5名女性慢性阻塞性肺疾病患者。通过定性访谈收集数据，并使用定性内容分析法进行分析以探寻意义。
主要主题是在健康人群的世界中感到被流放，原因是自责以及社会将慢性阻塞性肺疾病视为一种自身造成的疾病而加以污名化。参与者通过微妙的指责以及来自其社交网络、医疗保健接触和更广泛社会的支持不足而体验到耻辱感。这似乎增加了与疾病相关的压力以及采取防御行动的必要性。
必须考虑样本量小且为便利样本、当地文化影响、研究范围广泛以及缺乏卫生专业人员的观点等因素。
本研究阐明了在慢性阻塞性肺疾病的整个病程中如何将戒烟的健康建议与无指责的心理社会支持相结合的挑战。认识到污名化的可能性、尼古丁依赖的性质以及对该疾病更广泛的因果解释，可能会提高护理人员应对患者压力及其与应对和幸福感的负面关联的能力。关于慢性阻塞性肺疾病患者的耻辱感体验和负面情绪反应的健康沟通困境应进一步探讨。
