Smoking Counseling

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Smoking Counseling

  1. 1. Smoking Cessation Counseling Fayza Rayes MBBCh. Msc. MRCGP Consultant Family Physician Joint Program of Family & Community Medicine, Jeddah For more lectures and related topics you can visit www.fayzarayes.com
  2. 2. Mr. Ali, is a 45-year-old retired from military service.Presented with cough for 3 months. He hashypertension. He smokes 40 cigarettes per day. Hisfather died of coronary heart disease when aged 48.How you proceed?
  3. 3. Stott & Davis 1979Mr. Ali, is a 45-year-old retired from military service.Presented with cough for 3 months. He hashypertension. He smokes 40 cigarettes per day. Hisfather died of coronary heart disease when aged 48. Management of Management of Presenting Problem Continuous Problem Modification of Opportunistic health Help Seeking Promotion Behavior
  4. 4. Stott & Davis 1979Mr. Ali, is a 45-year-old retired from military service.Presented with cough for 3 months. He hashypertension. He smokes 40 cigarettes per day. Hisfather died of coronary heart disease when aged 48. Management of Management of Presenting Problem Continuous Problem Modification of Opportunistic Help Seeking health Promotion Behavior
  5. 5. Health Promotion
  6. 6. Definition of Health Promotion Action initiated by physician Change in patient’s behavior (smoking) To increase or promote patient’s health.
  7. 7. 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
  8. 8. Skills of Health Promotion:1. Choose appropriate time2. Ask to find out in which stage of change3. Proceed according to patients reaction4. Listen to the patient believes, worries and expectations5. Non-judgmental Motivational Counseling6. Make use of patients previous experience7. Use supportive measures8. Put action plan9. Use indicator to evaluate the progress10. Follow up visit and agree on suitable target
  9. 9. 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)
  10. 10. 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
  11. 11. Choose theappropriatetime & showyour patienthow much you care
  12. 12. Stages of Change ModelPrecontemplation Not thinking about change, uninterested May be resigned Feeling of no control Denial: does not believe it applies to self Believes consequences are not seriousContemplation Considering a change Weighing benefits and costs of behavior X proposed changePreparation Experimenting with small changesAction Taking a definitive action to changeMaintenance Maintaining new behavior over timeRelapse Experiencing normal part of process of change Usually feels demoralized
  13. 13. Precontemplation stageIf 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 patients barriers  Repetition: Reassess willingness to quit at subsequent visits; repeat intervention for unmotivated patients at every visit.
  14. 14. Precontemplation stage If pt. at Precontemplation stage discuss: Relevance Risks Rewards Roadblocks Repetition
  15. 15. Every body has a trigger point
  16. 16. Precontemplation stage If pt. at Precontemplation stage discuss: Relevance Risks Rewards Roadblocks Repetition
  17. 17. Precontemplation stage If pt. at Precontemplation stage discuss: Relevance Risks Rewards Roadblocks Repetition
  18. 18. Precontemplation stage If pt. at Precontemplation stage discuss: Relevance Risks Rewards Roadblocks Repetition
  19. 19. Precontemplation stageExercise :Discuss possible barriers to behavior change (Roadblocks)Barrier related to the patient: ………………………………………………………………………………… .……………………………………………………………………………….. ………………………………………………………………………………… .…………………………………………………………………………………Barrier related to the doctor-patient relationship: .……………………………………………………………………………….. …………………………………………………………………………………. ………………………………………………………………………………… …………………………………………………………………………………
  20. 20. Patient Reaction toSmoking Counseling Why some people respondimmediately while other people donot even think of quitting smoking
  21. 21. Precontemplation stageHealth Beliefs Model (1966)
  22. 22. Precontemplation stageHealth Beliefs Model (1966) Concept DefinitionPerceived Patients opinion of how strong he isSusceptibilityPerceived Patients opinion of how serious aSeriousness condition and its squeal are Patients opinion of the efficacy of thePerceived Benefits advised action to reduce risk or seriousness Patients opinion of the tangible andPerceived Barriers psychological costs of the advised actionCues to Action Pressure to activate compliance Confidence in patients ability to takeSelf-Efficacy action
  23. 23. How smoker may thinkAdvantages of smoking: Disadvantages: Prestigious  Against religion !! Increase concentration  Cost money Decrease appetite  Affect health Relaxation  Children health Fun  Bad smell Rebellion & Freedom  Not civilized … behavior  …
  24. 24. Health Beliefs Model Relation between anxiety and compliance Compliance AnxietyCompliance increase by moderate degree of anxietyBut …??
  25. 25. Health Beliefs Model Relation between anxiety and compliance Compliance AnxietyCompliance increase by moderate degree of anxiety but severe degree of anxiety decrease compliance
  26. 26. Barrier to changing Behavior Denial: “Not me” “I am young” “I am strong” “I walk every day” …..
  27. 27. Second Visit (within 10 days): Maintain effective dr-pt relationship Discuss action plan if the patient is ready Make use of pts previous experience Discuss withdrawal symptoms & management Use supportive measures  Family support  Nicotine supplement  Cognitive treatment
  28. 28. Use Supportive Measures:
  29. 29. Third Visit (within 1-2 Weeks): Maintain effective dr-pt relationship Follow up withdrawal symptoms Use indicator to evaluate the progress Agree on suitable targetBe flexible, empathic & give hope
  30. 30. Empathic & Respond to Patient Cues Till me about your smoking? Is this an appropriate time ?!
  31. 31. Appreciate Difficulties Quitting smoking is a hard task…
  32. 32. Give thepatient hope
  33. 33. Forth Visit (On demand): Maintain effective doctor-patient relationship Diagnose possible relapse early and manage If patient relapsed … start all over againBe patient,nonjudgmental& have hope
  34. 34. 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
  35. 35. Message to take home1. Opportunistic health promotion is a basic task in any consultation2. Be supportive, empathic, patient, nonjudgmental and have hope
  36. 36. Thank you

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