Motivational Tasks Associated with Patient Stages of Change
- Precontemplation – Not considering the possibility of change
- Raise doubt.Help patient understand the benefits of the unhealthy behaviour, while at the same time highlighting the costs
- Contemplation – Seriously thinking about change, but not ready to take action. The individual considers change and rejects it
- Tip the balance in favor of change: Strengthen patient self-efficacy to change by drawing upon past successes
- Preparation – Getting ready to change
- Help the patient identify small, realistic behavioural steps towards change
- Action – Actively engaged in a new healthier behaviour
- Support new behaviours, empathize difficulty of change behaviour
- Maintenance – Maintain new behaviour for several months
- Help the individual use new skills to prevent relapse
- Relapse – Return to old pattern of unhealthy behaviour
- Help the patient avoid discouragement and demoralization
Couselling and psychosocial Approaches
The 5A’s tool – for pt willing to Quit
- ASK: Tobacco use status updated for all pt on a regular Basis
- “Have you used any form of tobacco in the past 6mo?”
- Smoked: cigarettes, cigarillos, cigars, blunts, pipe, shisha, hookah, electronic cigarette
- Smokeless: chewing tobacco, dipping tobacco, dissolvable tobacco, snus, snuff
- Identify prev quit attempts and results
- Advice: Clearly advise pt to quit.
- make pt aware of withdrawal symptoms:
- low mood, insomnia, irritability, anxiety
- difficulty concentrating, restlessness
- decreased HR, increased appetite
- make pt aware of withdrawal symptoms:
- Assess: Assess the willingness of pt to begin Tx to achieve abstinence
- Assist: Offer assistance to every pt who expresses the willingness to begin Tx to quit
- Intensive interventions: dose-response relationship between the session length & successful Tx
- Provide resources / counselling: self-help, individual, group, helpline, web-based, motivational interviewing
- ≥ 4 counselling sessions >10min each with 6-12 months f/u yield better result
- Combination counselling and smoking cessation medication is more effective than either alone.
- Provide practical counselling on problem solving skills + provide support as a part of Tx
- Arrange:
- Regular f/u to assess response, provide support, and modify Tx
- Refer pt to relevant resources
Aboriginal People
- Tobacco misuse status updated on a regular basis
- Offer assistance to pt who misuse tobacco with specific emphasis on culturally appropriate methods
- Familiar w/ available cessation support services
- Seek appropriate training in providing evidence-based smoking cessation support
Hospital-Based population
- All pt should be made aware of hospital smoke-free policies
- Elective pt should be directed to resources to assist them to quit prior to admission or surgery
- All hospital should have systems in place to
- identify all smoker
- Rx nicotine withdrawal during hospitalization
- promote attempts toward long-term cessation
- Provide pt with f/u support post-hospitalization
- Pharmacotherapy
- to assist pt to manage nicotine withdrawal in hospital
- for use in-hospital & post-hospitalization to promote long term cessation
Mental health +/- other addicitons
- Screen pt with mental illness / additions for tobacco use
- Offer counselling & pharmacotherapy Tx to persons who smoke & have a mental illness / addiction to other substances
- While reducing smoking or quiting, monitor pt’s psychiatric condition(s): mental health status, other addicitons. Medication dosage be monitored and adjusted as necessary
Pregnant and Breastfeeding women
- Smoking cessation encourage for all pregnant, breastfeeding, postpartum women
- Counselling is 1st line Tx in pregnancy and breastfeeding
- If counselling ineffective, intermittent dosing nicotine replacement (lozenges, gum) are preferred over continuous dosing of the patch (↑risk)
- Partners, friends, family should also be offered smoking cessation interventions.
- A smoke-free home environment encouraged for pregnant and breastfeeding women to avoid exposure to second-hand smoke
Youth
- Obtain info about tobacco use – cigarettes, cigarillos, waterpipe, etc on a regular basis
- Couselling that supports abstinence from tobacco / cessation
- Counsel parents about the potential harmful effects of 2nd-hand smoke on the health of their children
Leave a Reply