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