cessation of smoking: issues and approaches Flashcards
What are the 3 principle fatal disease cause by smoking?
- COPD
- CVD
- cancer
What are the health benefits to smoking cessation?
- increased longevity
- accelerated decline in lung function reduced
- improved reproductive health
How does smoking cessation relate to risk lung cancer?
stabilisation of lung cancer risk but no absolute decline
How long does it take heart disease risk to reduce back to a non-smoker level after quitting?
10 years on average
How quickly are effects visible from quitting smoking?
20 minutes
What are the immediate effects on the body within 20 mins, 8 hours, 24 hours, 48 hours and 72 hours of quitting?
20 mins- normal pulse and blood pressure
8 hrs- blood nicotine and carbon monoxide levels halved
24 hours- CO eliminated, lungs begin clearing mucus
48 hours- nicotine eliminated, senses of smell+taste return
72 hours- breathing easier, bronchial tubes begin to relax
What are the long term effects of quitting smoking at 2-12 weeks, 3-9 months, 5 years and 10 years?
2-12- circulation improved
3-9- lung function increases >10%
5- risk of heart attack halved
10- lung cancer risk halved, risk of heart attack= non smoker level
At wat age if you stop by are almost all excessive risks of smoking ignored?
35 years
What proportion of all smokers will be killed by smoking?
half
How are post operative complications affected by smoking cessation?
- fewer wound related complications, reduced cardiovascular problems
- sorter hospital stay
What is a stage model? How does it relate to smoking?
- the certain stages people have to successfully get through to complete the model
- with smoking it is the stages smokers need to complete to become successful and quit
what stage model is used with smoking cessation?
Prochaska and DiClemente
What are the 6 components of the Prochaska and DiClemente stage model?
- pre-contemplative
- contemplative
- preparation
- action
- maintenance
- relapse
What is also coupled alongside the stage model?
nicotine replacement therapy such as: patches, gum etc.
What is the hardest barrier to cross when helping them quit?
getting them from the pre-contemplative stage to the contemplative stage
How long does it on average take for a smoker to quit?
- they go through 3 complete cycles of the stage model
- takes roughly 5 years
What are the key features of the pre contemplative stage? What is the strategy to overcoming it?
- lack of awareness or intent to change
- short messages to attract attention, bring up facts or information not previously mentioned or known about
What are the characteristics of the contemplative phase? what is the strategy to dealing with this phase?
- increased awareness of negative aspects of smoking
- dispel negative myths about quitting (on long term smoking increases anxiety and depression as the supposed calming effect)
What are the characteristics of the preparatory phase? what is the strategy to overcoming it?
- some small behavioural changes will have been made, set a quit date
- longer messages, offers concrete tips and methods to help quit
what are the characteristics of the action past? what is the strategy for dealing with the action phase?
- individual has plan to stop, still adjusting
- offer nicotine replacement therapy to avoid relapse and congratulate patient on success
What are the characteristics and strategies imposed in the maintenance phase?
- long term adjustment as a non-smoker
- congratulate advise ongoing vigilance to keep off cigarettes, be ware of trigger points where patient could relapse
What is the 4 A’s approach to smoking cessation? What is the potential 5th A?
1-ask about tobacco use 2-advise to quit (assess willingness to quit) 3-assisst in quit attempt 4-arragne follow up
Duration of the ask phase? What should you find out?
- 1 minute
- if they have ever? if yes have the stopped? Why ?
Duration of the advising phase? What 3 pieces of advice should you give?
- 1 minute
- clear strong personalised advice
What clear advice should you as a doctor give to a smoker?
best advice for you is to stop smoking now
what strong advice should be given?
as your clinician I need you to know quitting is thee most important thing you can do to benefit your health right now
what personalised advice can you give?
impact of smoking on the patients family and on their well-being
Duration of assess stage? how do you assess? What do you do if they are willing? what do you do if they are not willing?
- 1 minute
- in next 30 days assess willingness to quit
- if willing move on to assist step
- if not perform 5 Rs approach
duration of the assist stage? What do you do to help smoker quit?
- 3+ minutes
- suggest and encourage use of problem solving methods
- provide social support
- arrange social support in the smokers environment
- provide specific self help smoking cessation materials
duration of arrange phase? What should you do or plan in tis phase?
- 1+ minute
- follow up and monitor, provide support
- encourage patient
- invite to talk about success
- ask about concerns and difficulties
What are the 5Rs method to patients expressing an unwillingness to quit?
- relevance
- risks
- rewards
- roadblocks
- repetition
What is the purpose of the 5 Rs method?
- here is the information
- these are the dangers
- these are the benefits
- whats stopping you?
- keep saying this over and over
What reasons should you cover for smoking cessation to be relevant to a patient?
- financial
- children
- history of smoking related illness
What 2 methods should you use in the risks stage of 5Rs?
- what ave you heard about smoking?
- reiterate benefits for them and for children or family
What are the rewards of smoking cessation?
- financial
- O2 level improvement after a day
- smell and hygiene will improve
- more energy
What are the 4 potential roadblocks to smoking cessation or reasons for relapse?
- negative moods
- being around other smokers
- triggers and cravings
- time pressure
What advice can you give to overcome these roadblocks?
- suck on candy instead of smoking
- engage in physical activity
- ask for support
- engage and think of positive activities and things
- get others to quit with you
- leave room when others smoke
What advice do you give smokers to overcoming the roadblock specifically of triggers and cravings?
- get across that craving will reduce in a couple of weeks
- anticipate triggers= coffee, gatherings, waking up, after a meal
- change routine to accomodate
- distract yourself throughout the day with pleasant activities such as gardening or listening to music
