Smoking cessation

Question 1

How would you structure a smoking cessation consultation?

Answer 1

The 5 A’s, including ICE and smoking history

Question 2

What would you ask as part of the smoking history?

Answer 2

1. Quantity
2. Feelings
3. Finance
4. Quitting attempts

Also ask about PMH, drug history, family history and social history (alcohol and drug use)

Question 3

What are the five A’s?

Answer 3

1. Ask about the patient’s smoking status
2. Advise the patient to stop smoking
3. Assess smoking history and motivation to change
4. Assist using the STAR method
5. Arrange

Question 4

What evidence would you present to a patient who would like to stop smoking?

Answer 4

Numerous studies have shown that smoking is a risk factor for multiple conditions including cardiovascular disease, stroke and lung cancer. Smoking negatively impacts overall health and increases the burden on the healthcare system, costing the UK government 2.6 billion pounds in 2015 due to premature death, hospital admissions and loss of productivity.

Question 5

How would you quantify motivation to change?

Answer 5

Rate 0-10

• Pre-contemplation: no interest in changing behaviour
• Contemplation: an awareness of the negative aspects of smoking
• Preparation: an understanding of why they should quit smoking
• Action maintenance: an attempt to stop smoking
• Relapse: the attempt to quit was unsuccessful

Question 6

What is the STAR method?

Answer 6

Seta quit date based on the patient’s willingness, motivation and agreement. This should usually be within 2-4 weeks (abrupt quitting is usually more effective than gradual quitting).

Tellfamily and friends: advise the patient to make family and friends aware that they are quitting to provide further accountability and support.

Anticipatechallenges that a patient will face and make plans on how to overcome them.

Removeall tobacco products as well asrecommendcounselling programs and pharmacological therapies as indicated

Question 7

What are pharmacological interventions for smoking cessation?

Answer 7

Nicotine replacement therapy - This is normally used as the first-line therapy. It is available in multiple forms, including patches, sprays, and chewing gums

Bupropion - This is a dopamine and noradrenaline re-uptake inhibitor, which prevents cravings. The patients should be advised to start the treatment 1-2 weeks before they intend to stop

Varenicline (Champix) - This acts as a partial agonist of the nicotine receptors. It is the most effective pharmacological therapy, increasing successful cessation by up to 2x

Question 8

What are non-pharmacological interventions for smoking cessation?

Answer 8

Counselling

Question 9

What would you say during the arrange part of the 5 A’s?

Answer 9

Arrange afollow-up appointmentwithin 1-2 weeks to assess the patient’s progress

The highest rates of relapses are within thefirst three months of cessation

In the event of arelapse,reassurethe patient that this is not a set-back but merely a natural part of the behavioural modification process.

Patients will often needmultiple attemptsto achieve permanent cessation.

Question 10

How would you frame your ICE questions for smoking cessation?

Answer 10

• “How do you feel about smoking?”
• “Is there anything that worries you about smoking or giving up?”
• “What are you hoping to get from the visit today?”