Programme no. 242-OP
Public Health
Smoking status and barriers towards contact to general practice with respiratory alarm symptoms in the general population
Lisa Maria Falk Sele*1, Sandra Elnegaard2, Jens Søndergaard3, Kirubakaran Balasubramaniam4, Dorte Ejg Jarbøl5
1Research Unit of General Practice,Department of Public Health, University of Southern Denmark,Odense,Denmark, 2Research Unit of General Practice,Department of Public Health, University of Southern Denmark,Odense,Denmark, 3Research Unit of General Practice,Department of Public Health, University of Southern Denmark,Odense,Denmark, 4Research Unit of General Practice,Department of Public Health, University of Southern Denmark,Odense,Denmark, 5Research Unit of General Practice,Department of Public Health, University of Southern Denmark,Odense,Denmark
* = Presenting author
Objectives: To analyse the association between smoking status and four different barriers towards GP contact with respiratory alarm symptoms.
Background: In order to improve the prognosis and survival rates for lung cancer, the diagnosis should be made at an earlier stage. A prerequisite for this is for people to contact the general practitioner (GP), when they experience respiratory alarm symptoms (RAS), indicative of lung cancer. Smoking is a risk factor for lung cancer. Knowledge about barriers towards contact to GP with respiratory alarm symptoms in relation to smoking status is, however, sparse.
Results: Overall 49 706 subjects completed the questionnaire. Some 16.0% (7870) reported at least one respiratory alarm symptom. The proportion not having contacted the GP with RAS was highest for prolonged hoarseness (72.5%) and lowest for shortness of breath (50.3%). Of those who did not contact the GP with at least one respiratory alarm symptom 38.3% were current smokers, 28.6% were former smokers and 33.2% were never smokers.

In general ´being too busy´ (18.9%) and ‘being worried about wasting the doctor’s time’ (18.2%) were the most frequent barriers towards GP contact with RAS. Current smokers, who had not contacted the GP with at least one respiratory alarm symptom, were more likely to report ‘it would be embarrassing’ (OR 1.5 95% CI 1.1-2.2) and ‘being worried about what the doctor might find’ (OR 2.6 95% CI 2.1-3.2) compared to never smokers.

Material/Methods: A nationwide population-based cohort study. A total of 100 000 adults older than 20 years randomly selected from the Danish Civil Registration System were invited to participate in a web-based questionnaire. Items regarding RAS (prolonged coughing, shortness of breath, coughing up blood and prolonged hoarseness) experienced within the preceding four weeks, contact to the GP, barriers towards GP contact and smoking status were included in the questionnaire. The four barriers were ‘I would be too embarrassed’, ‘I would be worried about wasting the doctor’s time’, I would be worried about what the doctor might find’, and ‘I would be too busy to make time to visit the doctor’.
Conclusion:

‘Being worried about wasting the doctor’s time’ and ‘being too busy’ were the most frequent barriers towards GP contact with respiratory alarm symptoms. Smoking status was significantly associated with ‘it would be embarrassing’ and ‘being worried about what the doctor might find’.

Points for discussion: How does smoking status influence the relationship between patients and GPs?