10-10-22 - Cessation of Smoking - Issues and Approaches Flashcards
Learning outcomes
- To describe the general effects of use of tobacco on health
- To relate one example of Smoking and respiratory disease
- To outline the Stage Model of Behaviour Change (Prochaska and Di Clemente)
- To list the principles of Smoking Cessation (4 A’s and 5 R’s)
What are 3 reasons why people begin to smoke?
Why is smoking behaviour maintained?
What factors are important in smoking prevalence and cessation?
- 3 reasons people begin to smoke:
1) Experimenting with smoking - usually in early teenage years, driven predominantly by psycho-social motives
2) Influence of background (smoking in parents, siblings, peers; relatively deprived neighbourhoods; schools where smoking is common)
3) After the initial aversion, adolescent smokers inhale same amount of nicotine as adults - Smoking behaviour is maintained mainly by positive and negative reinforcing properties of nicotine
- Factors important in determining patterns of smoking prevalence and cessation:
1) Social
2) Economic
3) Personal
4) Political influences
What are fatal diseases caused by smoking?
How does smoking affect morbidity?
What are risks dependent on?
How many years of life do smokers lose?
- Fatal diseases caused by smoking:
1) Cancer
2) Chronic obstructive pulmonary disease (COPD
3) Cardiovascular disease (CVD) - Smoking is also an important cause of morbidity
- Risks are dose and duration dependent
- On average, cigarette smokers lose 7.5 years of life
How does smoking cessation affect total mortality?
- How smoking cessation affects total mortality:
- Cessation at age 50 yrs halved the risk, before age 30 yrs avoids almost all excess risk
- On average, cigarette smokers die 10 yrs younger than non-smokers
- Stopping at age 60, 50, 40, or 30 gains, respectively, about 3, 6, 9, or 10 years of life expectancy
What are 7 Health benefits of smoking cessation?
- Health benefits of smoking cessation:
1) Increased longevity
2) Stabilisation of lung cancer risk (not absolute decline)
3) Heart disease risk declines towards non-smoker level over 10 yrs
4) Accelerated decline in lung function reduced
5) Improved reproductive health
6) Improved recovery from surgery
7) Others
What are the 2 psychological pathways to smoking cessation?
- Psychological pathways to smoking cessation:
1) Transtheoretical Model of Behaviour Change
2) 4 A’s Approach to Smoking Cessation
What is the Transtheoretical Model of Behaviour Change?
What are the 5 stages on the model?
What are the characteristics of each stage?
What is the strategy on each stage?
What can occur if the patient relapses?
- The Transtheoretical Model of Behaviour Change is a stage model
- Proposes 5 stages of change:
1) Pre-contemplation
* Characteristics: Lack of Awareness or lack of intent to change (no intention of giving up smoking)
* Strategy: Short messages to attract attention, bring up potentially novel and highly relevant facts previously not considered
2) Contemplation
* Characteristics: Increased awareness of negative aspects of smoking. Beginning to consider giving up, probably at some ill-defined time in the future (has intention to quit within 6 months)
* Strategy: Dispel negative myths about quitting smoking; reinforce willpower to quit
3) Preparation
* Characteristics: Some small behavioural changes to quit have been made; intent to quit within 1 month (can set a “quit date”)
* Strategy: Longer messages, offer concrete tips and methods to help quit smoking
4) Action
* Characteristics: Individual has implemented plan to stop, still adjusting to the change (engaged in giving up smoking now)
* Strategy: Offer specific relapse prevention advice for nicotine dependence to include advice on the nicotine patch
5) Maintenance
* Characteristics: Long term adjustment as a non-smoker, content with new lifestyle without cigarettes (steady non-smoker, i.e. state of change reached)
* Strategy: Congratulate and advise ongoing vigilance to keep off cigarettes
- If the patient relapses (which is common), they will jump to a different stage in the model
What are the 3 pros and 2 cons of the Transtheoretical Model of Behaviour Change?
- 3 pros and 2 cons of the Transtheoretical Model of Behaviour Change:
- Pros:
1) Acknowledges individual stages of readiness, and allows for interventions to be tailored accordingly
2) May be useful for HCPs to know that some people are just not ready to change
3) Accounts for relapse - Negatives
1) Not all people move thorough every stage, some move backwards and forwards or miss some stages out completely
2) Change might operate on a continuum rather than in discrete stages
What is the 4As approach to smoking cessation?
Why is it sometimes called the 5 As?
What are the 5 As?
- The 4As approach to smoking cessation is a 4-step intervention proven effective:
1) Ask about tobacco use (1 minute)
* Ask which of the 5 statements best describes the patient’s cigarette smoking
2) Advice to quit (1 minute)
* Clear, strong, personalized advice to quit
* Personalized: Impact of smoking on the family and the patient’s well being
3) Assess willingness to make a quit attempt (1 minute)
* Assess patients’ willingness to quit within the next 30 days.
* If a patient responds that they would like to try to quit within the next 30 days, move on to the Assist step.
* If the patient does not want to try to quit, use the 5 R’s to try to increase motivation
4) Assist in quit attempt (3+ minutes)
* Suggest and encourage the use of problem solving methods and skills for smoking cessation
* Provide social support as part of the treatment
* Arrange social support in the smoker’s environment
* Provide specific self-help smoking cessation materials
5) Arrange follow-up (1+ minutes)
* Follow up to monitor progress and provide support
* Encourage the patient
* Express willingness to help
* Ask about concerns or difficulties
* Invite pt. to talk about his/her success
What are the 5Rs used for?
- If the patient does not want to try to quit smoking, use the 5 R’s to try to increase motivation
- The 5Rs:
1) Relevance (to patient)
* Ask pt to identify why quitting might be personally relevant:
* Children in their home
* Need for money
* History of smoking-related illness
2) Risks
* Ask, “What have you heard about smoking ?”
* Reiterate benefits for the patient and their children
3) Rewards
* Your will get more oxygen after just 1 day
* Your clothes and hair will smell better
* You will have more money
* Food will taste better
* You will have more energy
4) Roadblocks
* Negative moods
* Being around other smokers
* Triggers and cravings
* Time pressures
5) Repetition
What are 4 different roadblocks? What are ways of overcoming these?
- 4 different roadblocks:
1) Negative moods
* Hard candy
* Engage in physical activity
* Express yourself (write, talk)
* Relax
* Think about pleasant, +ve things
* Ask others for support
2) Other smokers
* Ask friend or relative to quit with you
* Ask others not to smoke around you
* Assign non-smoking areas
* Leave the room when others smoke
* Keep hands/ mouth busy
3) Triggers and cravings
* Cravings will lessen within a few weeks
* Anticipate “triggers”: coffee breaks, social gatherings, using phone, waking up
* Change routine - e.g. brush teeth immediately after eating
* Distract self with pleasant activities: garden, music
4) Time pressures
* Change your lifestyle to reduce stress
* Increase physical activity
What are 4 essential communication skills in smoking cessation?
- 4 essential communication skills in smoking cessation:
1) Minimal clinic smoking cessation advice can be powerful motivation to quit (Helpful even if <3 minutes (esp. when repeated))
2) Dose response curve with quit rate (show statistics)
3) Recommend 4-5 sessions of 10-15 mins
4) Advocate 4As and 5Rs
What 7 are negative beliefs held by GPs about smoking cessation?
- Negative beliefs held by GPs about smoking cessation:
1) Discussions too time consuming (42%)
2) Ineffective (38%)
3) Lacked confidence in cessation advice (22%)
4) Discussions unpleasant (18%)
5) Lacked confidence in knowledge (16%)
6) Cessation considered outside professional duty (5%)
7) Inappropriate (3%)
