Smoking Cessation - 5 Stages of Smoking Cessation
Of the 5 As for smoking cessation. What is the BARE MINIMUM a physican should do?
Ask Advise Then if you don't have time for the other 3 REFER! (Ask, advise, refer)
Smoking Cessation - 5 A's
Ask - about tobacco use (Do u smoke) Advise - (why should patient stop, make it relevant, i.e. talk about second hand smoke on their children) Assess - readiness to quit Assist - with cessation/attempt to quit Arrange follow up care
Not thinking about changing in the next 6 months
Stage 1 - (Assessing Readiness to Quit)
Pros of continued tobacco use outweight cons for patient
Stage 1 Precontemplation
patients are aware of need to quit but not ready to change yet
Stage 1 Precontemplation
struggle with ambivalence about change
Stage 1 Precontemplation
Use the 5 R's for increasing motivation to quit during WHAT STAGE?
Stage 2 Conteplation
aware of need to change and benifits and still struggles with ambivalence about change
Stage 2 Conteplation
Discuss the importance of behavioral conseling
Stage 3 (preparation)
Goal of Stage: Achieve cessation
Stage 3 (preparation)
Note: pharmacotherapy is a TREATMENT to get off nicotine not a crutch
Stage 3 (preparation)
Recommend use of Tobacco use log
Stage 3 (preparation)
Stage - Behavioral coping strategies set actions to reduce risk of relapse (example - do not go to poker night)
Stage 3 (preparation)
Stage - Cognitive coping strategies allow for retraining of the way patient thinks
Stage 3 (preparation)
Stage - discuss pros and cons of available methods
Stage 3 (preparation)
Stage - medication counseling: promote compliance with meds and discuss proper use with demonstration
Stage 3 (preparation)
Stage - set a quit date
Stage 3 (preparation)
Congratulate the patient (3)
Stage 3 through
Patients have quit useing tobacco sometime in past 6 months and are taking steps to increase success
Stage 4 (Action)
Stage - Goal: remain tobacco free for at least 6 months
Stage 4 (Action)
Ongoing relapse prevention needed (Patients remain vulnerable to relapse)
Stage 5 (Maintenence)
Remain tobacco free for life
Stage 5 (Maintenence)
Stage 1 - (Assessing Readiness to Quit)
Precontemplation
Stage 3
Preparation
5 R's for increasing motivation to quit
Relevance Risks Rewards Roadblocks Repetition
What warnings should you give the patient (2)
- weight gain possible - withdrawal symptoms (will pass in 2-4 wks after quiting)
Information collected in Tobacco use log
- when (difficulat times of day) - why (situations/triggers)
when should Follow-up contact #1 occur
1st week after quiting
Stage 4
Action
Purpose of 5 R's for increasing motivation to quit
Ask patient questions so they can LEAD THEMSELVES to be motivated enough to quit. Example - Relevance - how important is it to continue smoking Risks - what do you think the risks are to continue smoking (children, money, self) Rewards Roadblocks Repetition - do this again the next time the patient comes back in
Stage 2 - (Assessing Readiness to Quit)
Considering changing in the next 6 mons but not in next month
Stage 2
Conteplation
Discuss following Key Issues: -Their Motivations to quit/avoid relapse -Confidence in ability to quit -Triggers for tobacco use -Routines/situations associated with tobacco use
Discuss following Key Issues: Their Motivations to quit/avoid relapse Confidence in ability to quit Triggers for tobacco use Routines/situations associated with tobacco use - driving car - stress - friends
Stage 5
Maintenance
Stage 5 - (Assessing Readiness to Quit)
Former user quit >6 months ago
Stage 3 - (Assessing Readiness to Quit)
Getting ready to change in next 30 days
Stage 4 - (Assessing Readiness to Quit)
In the process of changing
Tobacco cessation counseling increases or decreases patient satisfaction
Increases
What are 2 questiosn to ask about triggers for tobacco use
What situations led to temptations in past What lead to relapse in past
Goal of Tobacco use log
helps patient develop a coping stragity to overcome temptations
What action should the physician take for a slip?
let a slip slide (1 cigarette followed by return to cessation)
What is 1 area in which a patient can increase their success after quiting smoking?
manage withdrawal symptoms
Important info to collect on Tobacco use hx (4)
types of tobacco (brand, chewing/smoking) Amount (# of cigarettes) Duration of Use Past Attempts to quit
What information is important to collect on patient's past attempts to quit
what works (method used)? what doesn't work (i.e. gum) why relapse? Compliance, duration
when should Follow-up contact #2 occur
within first month after quiting
