Cessation of Smoking

Question 1

What is the psychological pathway of smoking cessation?

Answer 1

• transtheoretical model of behaviour change

- stage model

Question 2

What are the different stages of behaviour change?

Answer 2

• pre-contemplation
• contemplation
• preparation
• action
• maintenance
• relapse
  (goes back)

Question 3

Describe the pre-contemplation stage and how clinicians can target this

Answer 3

• characteristics: lack of awareness/intent to change

- strategy: short messages/facts to attract attention

Question 4

Describe the contemplation stage and how clinicians can target this

Answer 4

• characteristics: *increased awareness of negative aspects of smoking
• intention to quit in 6 months
• strategy: debunk negative myths surrounding smoking cessation to reinforce willpower to quit

Question 5

Describe the preparation stage and how clinicians can target this

Answer 5

• characteristics: small behavioural changes to quit, ‘quit date’ set
• strategy:
• longer messages
• concrete tips and methods to help quit smoking

Question 6

Describe the action stage and how clinicians can target this

Answer 6

• characteristics: implemented plan to stop, adjusting to change
• strategy: offer relapse prevention advice including nicotine patch advice

Question 7

Describe the maintenance stage and how clinicians can target this

Answer 7

• characteristics: long term adjustment, content with new lifestyle
• strategy: congratulate and advise ongoing vigilance to keep off cigarettes

Question 8

What are the 4 A’s approach to smoking cessation?

Answer 8

• ask about tobacco use
• ask to quit
• assist in quit attempt
• arrange follow up

Question 9

What is a key step between advise and assist in the 4 A’s approach for clinicians to check?

Answer 9

• assess willingness of individual to make an attempt to quit
• might need extra support/assistance

Question 10

Describe how to advise a patient to quit smoking

Answer 10

clear, strong, personalised advice to quit

Question 11

What if you assess your patient to not be willing to quit within the next 30 days?

Answer 11

Use the 5 R’s to try and increase motivation

Question 12

Describe how to assist a patient to quit smoking

Answer 12

• suggest/encourage use of problem solving methods and skills for smoking cessation
• provide social support
• provide specific self-help materials for quitting smoking

Question 13

Describe how you would arrange to help a patient stop smoking

Answer 13

• follow up to monitor progress and provide support
• encourage patient
• express willingness to help
• ask about concerns and difficulties
• invite to talk about success

Question 14

Describe the 5 R’s of increasing motivation to quit

Answer 14

• relevance: ask patient to identify why quitting smoking is right for them (money/illness etc)
• Risks: reiterate benefits of quitting for patient/patient’s family
• Rewards: tell patient benefits (you will have more money/food tastes better/more energy)
• Roadblocks: getting around barriers like negative mood/triggers/cravings/being around other smokers

Question 15

How can you advise a patient around roadblocks in the 5 R’s?

Answer 15

• negative moods: do physical activity/relax/think positive things/ask for support
• other smokers: ask a friend to quit with you/ask others to not smoke around you/keep hands and mouth busy
• triggers/cravings: anticipate triggers and change routine/distract yourself with pleasant activities