Management Interview - Smoking cessation

Question 1

Questions for smoking cessation

Answer 1

INTRODUCE YOURSELF

Smoking history:
* Psychosocial history
* When he started smoking, context, reason
* How much does he smoke per day
* the impact of smoking on the patient and, other social and psychological factors

Assess nicotine dependence: which cigarette most important, how long before first cigarette, can resist smoking in public areas, etc.
* Quit before? Success? How?
* Assess readiness level

Barriers and facilitators
* Knowledge about risks of smoking
* How smoking affect family/work/life
* Facilitator: wife, family, save money
* Identifies the use of motivation language in the consultation (DARN - CAT)

Management advice
* Explain nature and risks of smoking
* Motivate patient to change and accept management
* Advises appropriate need, choice, effect and side effects of drug or non-drug treatments if applicable
* Provides follow up instructions

Set a quitting date: Advise to pick one day to start

Give motivation: “you are a good husband and will be a good father”

Answer questions

Question 2

Smoking cessation options

Answer 2

Nicotine Replacement Therapy (NRT):
* Mode of Action: Provides controlled doses of nicotine to help reduce withdrawal symptoms and cravings
* Side Effects: Mild skin irritation with patches, mouth/jaw soreness with gum, hiccups with lozenges
* Prescription: Over-the-counter, no prescription required

Bupropion (Zyban):
* Mode of Action: Increases levels of dopamine and norepinephrine in the brain to help reduce cravings and withdrawal
* Side Effects: Insomnia, dry mouth, headache, seizure risk (rare)
* Prescription: Requires a prescription from a healthcare provider

Varenicline (Chantix):
* Mode of Action: Targets nicotine receptors in the brain, reducing cravings and blocking the effects of nicotine
* Side Effects: Nausea, sleep disturbances, mood changes, increased risk of cardiovascular events
* Prescription: Requires a prescription from a healthcare provider

Combination Therapy:
Mode of Action: Uses a combination of NRT and prescription medications to target multiple mechanisms

Question 3

Techniques to motivate patient change

Answer 3

‘Spirit’ of MI

Asks Open-ended questions

Explore the cognitive reasoning behind patient’s choices

Uses patient-centred rather than doctor-centred communication

Use effective communication skills
i.e.
 Makes Affirmations (compliments, validates, notices the patient’s strengths and/or efforts)

 Uses Reflections (paraphrases a statement to capture the meaning or amplify/ reinforce a desire for change)

 Uses Summarising (points out discrepancies between the patient’s current situation and future goals)

Question 4

Smoking

Reasons for smoking

Answer 4

Common reasons of smoking in smokers
- Over-learnt habit
- Association and secondary reinforcement: Intertwined with daily life events: Fun, Grown-up, Male image, Boredom
- Routine
- Craving
- Stress
- Social-peer pressure
- Relaxation

Question 5

Smoking cessation

Possible motivations

Answer 5

Need to find a personal reason to quit smoking
- Save money
- More acceptable socially
- Not harm others
- Improve health (not limited to COPD and CA Lung but CA of other systems)
- Clothes and home smell fresher
- Increase appreciation of taste, smell
- Fire hazards

Question 6

Smoking cessation

Withdrawal symptoms

Answer 6

Withdrawal Symptoms
- Craving
- Coughing
- Hunger and weight gain
- Bowel disturbance
- Sleep disturbance
- Dizziness and paresthesia
- Mood swings, lack of concentration and irritability