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Tobacco cessation fall 2011 Instructor (1)_ For use in lecture (3)

They are aware of the benefits of quitting but they

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 They are aware of the benefits of quitting.  But they struggle with ambivalence about change. GOAL:  Move the patient into the preparation stage. ASSESSING  READINESS to QUIT  (cont’d) STAGE 2: Contemplation
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DOs Strongly advise to quit Provide information Identify reasons for tobacco use Demonstrate empathy; increase  motivation Encourage self-reevaluation of  concerns Offer encouragement DON’Ts Persuade “Cheerlead” Tell patient how  bad tobacco is, in  a judgmental  manner Provide a  treatment plan STAGE 2: CONTEMPLATION Counseling Strategies
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The 5 R’s—Methods for increasing  motivation: Relevance Risks Rewards Roadblocks Repetition Fiore et al. (2000). Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: USDHHS, PHS. Tailored, motivational messages NOT READY TO QUIT:  Counseling Strategies  (cont’d)
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NOT READY to QUIT A Demonstration CASE SCENARIO:   Ms. Lilly Vitale You are a clinician providing care to  Ms. Vitale, a young woman with  early-stage emphysema. VIDEO # V6a
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Ready to quit in the next 30 days Patients are aware of the need to, and the benefits of,  making the behavioral change. Patients are getting ready to take action. STAGE 3: Preparation ASSESSING  READINESS to QUIT  (cont’d) GOAL:  Achieve cessation.
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Assess tobacco use history Discuss key issues  Facilitate quitting process Practical counseling (problem solving/skills training) Social support delivered as part of treatment STAGE 3: PREPARATION Three Key Elements of  Counseling HANDOUT
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STAGE 3: PREPARATION Assess Tobacco Use History Praise the patient’s readiness Assess tobacco use history Current use: type(s) of tobacco, brand, amount Past use: duration, recent changes Past quit attempts: Number, date, length Methods used, compliance, duration Reasons for relapse
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Reasons/motivation to quit (or avoid relapse) Confidence in ability to quit (or avoid relapse) Triggers for tobacco use What situations lead to temptations to use tobacco? What led to relapse in the past? Routines/situations associated with tobacco use STAGE 3: PREPARATION Discuss Key Issues When drinking coffee While driving in the car  When bored or stressed While watching television While at a bar with friends After meals During breaks at work While on the telephone While with specific friends or family  members who use tobacco
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“Smoking gets rid of all my  stress.” “I can’t relax without a  cigarette.” There will always be stress  in one’s life.
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