Coaching, Motivational Interviewing and Brief Interventions (2) Flashcards

Question

What behaviours do behavioural support groups target?

Answer 1

``` Reduce motivation to smoke Commitment to abstain Enhance ability to cope with cravings Ensure effective use of pharmacotherapy ```

Answer 2

Most effective (at top) - Group - 1-2-1 • Telephone helpline • Text messaging programmes • Stop smoking websites • Stop smoking books • Smartphone apps Least effective (at bottom)

Answer 3

``` Nicotine Replacement Therapy 8-12 week treatment, - nicotine needs to weaned off slowly 9 different forms - Significantly reduces withdrawal symptoms and cravings vs placebo - Significantly increases smoking cessation rate vs placebo (odds ratio = 1.58) = 58% - Standard regime is to start NRT on quit date - Combination use now routine ```

Answer 4

``` Pros: Does not contain the carcinogens found in tobacco Mimics their behaviour more closely 95% safer than smoking As effective as NRTs ``` Cons: Long-term side effects unknown Many people decide to smoke actual cigarettes alongside e-cigarettes

Answer 5

Plasma nicotine levels are higher from cigarettes than in NRT so essential treatment plan is followed strictly - Use enough - avoid under-dosing and irregular use - Long enough - don't stop early, continue 8-12 weeks to desensitise the receptors - NOT A PUFF! Slower and less efficient source of nicotine than cigarettes so can not compete.

Answer 6

Originally developed to treat depression Modifies dopamine levels and noradrenergic actvity Significantly increased smoking cessation rate by 1.94x compared to placebo Insomnia Dry mouth Headache? Nausea

Answer 7

Partial nicotine agonist and partial nicotine antagonist Part blocking - reduces pleasurable effects of smoking Part stimulating - relieves craving and withdrawal symptoms Higher abstinence prevalence than bupropion

Answer 8

Key Points a. Smoking comes at a huge cost to the NHS and public health. It impacts every tissue type in the body, leading to an array of cancers and other health issues. b. The most effective interventions for stopping smoking are nicotine replacement, pharmacotherapy (bupropion and varenicline) combined with group support: willpower is usually not enough to overcome an addiction. c. Very Brief Advice and MECC have been shown to have positive impacts on the uptake of stopping smoking services. d. VBA does not engage a person in a conversation but rather assumes they want to change and points them in the direction of support. Because of this it can feel awkward to do at first- practice is key. Department of Primary Care & Public Health School of Public Health Page 19 of 21 e. Different trusts and local authorities will have different services available so it is essential you familiarise yourself with what is available so you can effectively refer on at the end of the VBA process.

Answer 9

Cigarette smoke contains more than 4,000 chemicals, including over 60 known carcinogens and metabolic poisons ``` Nicotine Tar Arsenic Carbon monoxide Cadmium Hydrogen Cyanide Ammonia Toluene Phenol Nitrosamine Butane Naphthalene DDT ```

Answer 10

``` “Since all motivated quitters should be given the optimum chance of success in any given quit attempt, nicotine replacement therapy (NRT), Champix (varenicline) and Zyban (bupropion) should all be made widely available in combination with intensive behavioural support as first-line treatments (where clinically appropriate ```

Answer 11

§ First recommend varenicline, bupropion and combination NRT for cessation – and if smokers won’t use these, then it is reasonable to recommend use of e-cigarettes § Always recommend support- stop smoking services do support quit attempts with e-cigs § Advise complete cessation of smoking with e-cigarettes not smoking reduction (45%-60% e-cig users continue to smoke)

Answer 12

- Advice on quitting smoking from a doctor can be one of the most important triggers for a quit attempt

Answer 13

A simple form of advice designed for busy clinicians to be used opportunistically in less than 30 seconds in almost any consultation with a smoker by telling them how to stop and directing them

Answer 14

1. Establish and record smoking status: “Do you smoke? / Are you still smoking?” 2. Advise how to stop: “The best way to stop is with support and treatment” 3. Offer support and treatment: “When you are ready just make an appointment with [XXX] who is great!”

Answer 15

``` VBA DELIBERATELY AVOIDS “CHALLENGING THE ADDICTION” SO DOES NOT: • Advise smokers to stop • Ask how much or what they smoke • Ask if they want to stop ```

Answer 16

The BWeL trial tested the effect of a very brief behaviourally-informed opportunistic intervention delivered by GPs to patients who were consulting who were obese and where weight loss was not the focus of the consultation. The study showed that brief interventions are effective for weight loss, but we also know that GPs and other healthcare professionals rarely use them. We are pursuing a programme of research to support implementation 30 seconds - advise - offer referral to weight loss programme on prescription and make the appointment while in surgery - 4 in 10 people attended - 8 in 10 felt it was appropriate and helpful - weight loss seen more in those referred

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Coaching, Motivational Interviewing and Brief Interventions (2) Flashcards

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