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Smoking Cessation Counseling
Fayza RayesMBBCh. Msc. MRCGP
Consultant Family Physician
Joint Program of Family & Community Medicine, Jeddah
For more lectures and related topics you can visit
www.fayzarayes.com
Mr. Ali, is a 45-year-old retired from military service. Presented with cough for 3 months. He has hypertension. He smokes 40 cigarettes per day. His father died of coronary heart disease when aged 48.
How you proceed?
Management of Presenting Problem
Management of Continuous
Problem
Modification of Help Seeking
Behavior
Opportunistic health Promotion
Stott & Davis 1979
Mr. Ali, is a 45-year-old retired from military service. Presented with cough for 3 months. He has hypertension. He smokes 40 cigarettes per day. His father died of coronary heart disease when aged 48.
Management of Presenting Problem
Management of Continuous
Problem
Modification of Help Seeking
Behavior
Opportunistic health
Promotion
Stott & Davis 1979
Mr. Ali, is a 45-year-old retired from military service. Presented with cough for 3 months. He has hypertension. He smokes 40 cigarettes per day. His father died of coronary heart disease when aged 48.
Health Promotion
Definition of Health Promotion
Action initiated by physician
Change in patient’s behavior
(smoking)
To increase or promote patient’s health.
Strategies of Intervention
Minimal: 1 session less than 3 min
Intermediate: 2 to 3 sessions 3 to 10 min
Intensive program: Greater than or equal
to 4 sessions greater than 10 min
Skills of Health Promotion:1. Choose appropriate time
2. Ask to find out in which stage of change
3. Proceed according to patient's reaction
4. Listen to the patient believes, worries and expectations
5. Non-judgmental Motivational Counseling
6. Make use of patient's previous experience
7. Use supportive measures
8. Put action plan
9. Use indicator to evaluate the progress
10. Follow up visit and agree on suitable target
Behavioral Counseling
Smoking diary Progressive restriction Find alternatives to oral and hand activity Avoid smoking cues e.g. coffee and cigarettes (take
orange juice instead), smoking 30 minutes after awakening (exercise)
Remove all ashtrays from the surrounding environment
Encourage partner to stop smoking Tell friends that they are going to stop Avoid situations that tempt you to smoke (parties)
First Visit: Establish rapport
Find out in which stage of change
Give objective information about smoking Non-judgmental Motivational Counseling
Discuss the pros and cons of smoking &quitting
Measure: Wt. Ht. BP. BFM (if COPD)
Do basic screening tests:
lipids & Blood sugar
Choose the
appropriate
time & show
your patient
how much
you care
Stages of Change ModelPrecontemplationNot thinking about change, uninterested
May be resignedFeeling of no controlDenial: does not believe it applies to self Believes consequences are not serious
ContemplationConsidering a changeWeighing benefits and costs of behavior X proposed change
PreparationExperimenting with small changes
ActionTaking a definitive action to change
MaintenanceMaintaining new behavior over time
RelapseExperiencing normal part of process of changeUsually feels demoralized
If pt. at Precontemplation stage discuss: Relevance: connection between tobacco use and
current symptoms, disease and medical history Risks: risks of continued tobacco use and tailor the
message to individual risk/relevance of cardiovascular disease or exacerbation of preexisting disease
Rewards: potential benefits for quitting tobacco use to their medical, financial, and psychosocial well-being
Roadblocks: barriers to quitting and discuss options and strategies to address patient's barriers
Repetition: Reassess willingness to quit at subsequent visits; repeat intervention for unmotivated patients at every visit.
Precontemplation stage
Relevance
Risks Rewards
Roadblocks
Repetition
Precontemplation stage
If pt. at Precontemplation stage discuss:
Every body has a trigger point
If pt. at Precontemplation stage discuss:
Relevance
Risks
Rewards
Roadblocks
Repetition
Precontemplation stage
Precontemplation stage
If pt. at Precontemplation stage discuss:
Relevance
Risks
Rewards
Roadblocks
Repetition
Precontemplation stage
If pt. at Precontemplation stage discuss:
Relevance
Risks
Rewards
Roadblocks
Repetition
Exercise :
Discuss possible barriers to behavior change (Roadblocks)
Barrier related to the patient: ………………………………………………………………………………… .……………………………………………………………………………….. ………………………………………………………………………………… .…………………………………………………………………………………
Barrier related to the doctor-patient relationship: .……………………………………………………………………………….. …………………………………………………………………………………. ………………………………………………………………………………… …………………………………………………………………………………
Precontemplation stage
Patient Reaction to Smoking Counseling
Why some people respond
immediately while other
people do not even think of
quitting smoking
Precontemplation stagePrecontemplation stage
Health Beliefs Model (1966)
Concept Definition
Perceived Susceptibility
Patient's opinion of how strong he is
Perceived Seriousness
Patient's opinion of how serious a condition and its squeal are
Perceived Benefits
Patient's opinion of the efficacy of the advised action to reduce risk or seriousness
Perceived Barriers
Patient's opinion of the tangible and psychological costs of the advised action
Cues to ActionPressure to activate compliance
Self-EfficacyConfidence in patient's ability to take action
Precontemplation stagePrecontemplation stage
Health Beliefs Model (1966)
How smoker may think
Advantages of smoking: Prestigious Increase concentration Decrease appetite Relaxation Fun Rebellion & Freedom …
Disadvantages: Against religion !! Cost money Affect health Children health Bad smell Not civilized
behavior …
Relation between anxiety and compliance
Compliance increase by moderate degree of anxiety But …??
Anxiety
Compliance
Health Beliefs Model
Relation between anxiety and compliance
Anxiety
Compliance
Compliance increase by moderate degree of anxiety but severe degree of anxiety decrease compliance
Health Beliefs Model
Barrier to changing Barrier to changing
BehaviorBehavior
Denial:Denial: “Not me” “I am young” “I am strong” “I walk every day” …..
Second Visit (within 10 days):
Maintain effective dr-pt relationship Discuss action plan if the patient is
ready Make use of pt's previous experience Discuss withdrawal symptoms &
management Use supportive measures
Family support Nicotine supplement Cognitive treatment
Use Supportive Measures:
Third Visit (within 1-2 Weeks):
Maintain effective dr-pt relationship
Follow up withdrawal symptoms
Use indicator to evaluate the progress
Agree on suitable target
Be flexible, empathic & give hope
Empathic & Respond to Patient Cues
Is this an appropriate time ?!
Till me about your smoking?
Quitting smoking is a hard task…
Appreciate Difficulties
Give the patient hopehope
Forth Visit (On demand):
Maintain effective doctor-patient relationship
Diagnose possible relapse early and manage
If patient relapsed … start all over again
Be patient,
nonjudgmental
& have hope
Common Mistakes in Counseling
Some patients are hopeless and no need to counsel them
Trying to convince the patient to change behavior irrespective to his readiness to change
Threat the patients instead of instill hope
No enough follow up
Message to take home
1. Opportunistic health promotion is
a basic task in any consultation
2. Be supportive, empathic, patient, nonjudgmental and have hope
Thank you