Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Division of Primary Care, University of Nottingham, Nottingham, UK.
Addiction. 2022 May;117(5):1427-1437. doi: 10.1111/add.15760. Epub 2021 Dec 23.
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.
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.
Primary care clinics in England.
PARTICIPANTS/CASES: Twenty-one patients and 11 clinicians, purposively sampled from an RCT.
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.
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.
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.
临床医生可以向那些无法戒烟的吸烟者推荐电子烟以减少危害，但许多临床医生对此感到不安。在一项随机对照试验（RCT）中，初级保健临床医生提供免费电子烟，并鼓励不愿意戒烟的慢性病患者改用电子烟。我们采访了临床医生和患者，以了解如何在常规实践中采用减少危害的方法。
在一项 RCT 中进行定性分析，包括对提供试验干预的初级保健临床医生和参与的患者进行半结构化访谈的主题分析。
英格兰的初级保健诊所。
参与者/病例：从 RCT 中有意抽样的 21 名患者和 11 名临床医生。
我们定性探讨了患者和临床医生对以下方面的经验：提供/收到电子烟、过去和现在对电子烟的看法以及应用减少危害方法。
四个主题捕捉到了临床医生和患者报告的观点。这些主题包括：（1）安全/风险的概念，临床医生担心推荐一种具有未知长期风险的产品，而患者则更喜欢香烟的已知风险；（2）临床医生觉得他们提供这些产品就像是在开处方，这很冒险，而患者并不认同这种观点；（3）将戒烟等同于成功，因为患者和临床医生都将电子烟视为戒烟辅助工具；（4）观点不变，因为临床医生报告说培训并没有改变他们对电子烟的现有看法。这些主题被一个更高层次的概念“旧的和熟悉的与新的和未知的相遇”统一起来，这是这种新方法与长期存在的方法之间的矛盾，是这些担忧的基础。
定性分析发现，临床医生和患者在接受电子烟减少危害而不是作为支持戒烟的辅助工具方面存在障碍：即使在接受了有针对性的培训后，临床医生也难以将减少危害与他们现有的实践伦理模式相协调，而患者则将电子烟视为戒烟辅助工具。
