Brief preoperative smoking cessation counselling in relation to breast cancer surgery: A qualitative study Thordis Thomsen a, * , Bente Appel Esbensen b , Susanne Samuelsen c , Hanne Tønnesen d , Ann M. Møller e a Research and Development Unit, Department of Anaesthesiology, Herlev University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark b Bente Appel Esbensen, Research Unit, Hillerød Hospital, Helsevej 2, DK-3400 Hillerød, Denmark c Centre for Prevention and Health Promotion, Fredensborg Municipality, Egevangen 3B, DK-2980 Fredensborg, Denmark d Clinical Unit of Health Promotion/WHO Collaborating Centre for Evidence-Based Health Promotion, Bispebjerg University Hospital, DK-2400 Copenhagen, Denmark e Research and Development Unit, Department of Anaesthesiology, Herlev University Hospital, DK-2730 Herlev, Denmark Keywords: Brief preoperative smoking intervention Cancer Cessation Risk reduction Experience Counselling abstract Aim: To describe how women smokers with newly diagnosed breast cancer experienced brief preop- erative smoking cessation intervention in relation to breast cancer surgery. Background: Preoperative smoking cessation intervention is relevant for short- and long-term risk reduction in newly diagnosed cancer patients. Our knowledge of how patients with malignant diagnoses experience preoperative smoking intervention is however scarce. Methods: A qualitative descriptive study that collected data through one-time individual, semi-struc- tured interviews with 11 Danish women. Ricoeur’s theory of interpretation was used for the analysis. Results: The women experienced that brief preoperative smoking intervention triggered reflection upon smoking and health. They furthermore experienced the smoking intervention as an opportune aid to escaping the social stigma of being a smoker. Quitting in the context of cancer diagnosis was difficult for some women. They relapsed to smoking as an ingrown response to emotional distress. The smoking intervention heightened the women’s awareness of their addiction to smoking; however, they expressed a need for prolonged smoking cessation support. For others, the smoking intervention was supportive of cessation, and these women experienced smoking cessation as an enactment of a duty of responsibility to themselves and those nearest to them. They furthermore experienced a sense of personal achieve- ment, improved well-being and endorsement from family and friends. Conclusion: In newly diagnosed breast cancer patients, brief preoperative smoking intervention moti- vated smoking cessation. However, prolonged intervention, pre- and postoperatively, may more effec- tively support cessation in breast cancer patients and should therefore be evaluated in this patient population. Ó 2009 Elsevier Ltd. All rights reserved. Introduction Smoking is the cause of a range of debilitating conditions and the positive effects of smoking cessation on public health are unequivocal (Doll et al., 2004). Furthermore, smoking is a well- known risk for postoperative complications and there is growing evidence of the beneficial effect of preoperative cessation of smoking on postoperative recovery (Thomsen et al., 2009). The incentive to advise cancer patients to stop smoking prior to cancer surgery is therefore strong. Four recent randomised controlled trials have reported that intensive counselling to stop smoking 4–8 weeks prior to elective, non-malignant surgery significantly reduced postoperative complications and increased long-term smoking cessation rates (Moller et al., 2002; Sadr Azodi et al., 2009; Lindstrom et al., 2008; Villebro et al., 2008). Patients accepted the counselling and recommended that routine preoperative smoking cessation advice be implemented (Møller and Villebro, 2004). Patients furthermore ascribed their motivation to stop smoking in relation to surgery to the provision of preoperative cessation advice (Møller and Villebro, 2004). Patients scheduled for cancer surgery may experience preop- erative smoking cessation counselling differently. Cancer patients suffer differing degrees of anxiety, uncertainty and vulnerability following diagnosis (Halstead and Hull, 2001). They also have to * Corresponding author. Tel.: þ45 44 883 595; fax þ45 44 534 806. E-mail address: thotho02@heh.regionh.dk (T. Thomsen). Contents lists available at ScienceDirect European Journal of Oncology Nursing journal homepage: www.elsevier.com/locate/ejon 1462-3889/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejon.2009.04.006 European Journal of Oncology Nursing 13 (2009) 344–349