• Julie S Wilson, Joseph S Elborn, and Donna Fitzsimons.
• Nursing Research & Development, Belfast Health and Social Care Trust and University of Ulster, Ulster, UK. js.wilson@ulster.ac.uk
• J Clin Nurs. 2011 Mar 1; 20 (5-6): 819-27.

AimThis study aims to explore the experience of cigarette smokers with Chronic obstructive pulmonary disease (COPD) who have received smoking cessation support and describe their personal decision-making processes regarding their smoking behaviour.BackgroundPrevious studies have demonstrated poor smoking cessation rates in people with COPD, despite this being the primary intervention for disease management. There is limited research exploring the reasons why this population continues to smoke.DesignRetrospective qualitative interviews were conducted and analysed using Giorgi's (1985) process of analysis.MethodFollowing a randomised controlled trial to evaluate national smoking cessation guidelines, semi-structured interviews were conducted with a purposive sample (n = 6) of those patients who were unable to stop smoking.ResultsSix themes that typified patients' decision-making were identified during six interviews; too late to stop now, finding motivation, guilt about continued smoking, bargaining/contemplation, need to stop and reduced quality of life.ConclusionThe reasons why smokers with COPD continue to smoke despite poor health and following support are complex. Cigarettes are regarded as friends, despite the knowledge that they are contributing to severe disability and poor quality of life. Owing to their inability to stop smoking, many patients avoid healthcare opportunities, further contributing to their poor health.Relevance To Clinical PracticeSmoking cessation is associated with ambivalence in this population. Health professionals need to understand the volatility of patients' decision-making and tailor advice and support to achieve more realistic goals such as reduced consumption.© 2010 Blackwell Publishing Ltd.

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