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

Provide assistance throughout the quit attempt fiore

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Provide assistance throughout the quit attempt. Fiore et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: USDHHS, PHS, May 2008.
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The 5 A’s: REVIEW ASK about tobacco USE ADVISE tobacco users to QUIT ASSESS READINESS to make a quit attempt ASSIST with the QUIT ATTEMPT ARRANGE FOLLOW-UP care
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Faced with change, most people are not ready to act.  Change is a process, not a single step. Typically, it takes multiple attempts. HOW CAN I LIVE  WITHOUT TOBACCO? The (DIFFICULT) DECISION  to QUIT
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HELPING SMOKERS QUIT IS  a CLINICIAN’S  RESPONSIBILITY THE  DECISION  TO QUIT LIES IN THE  HANDS OF EACH PATIENT. TOBACCO USERS DON’T PLAN TO FAIL.   MOST FAIL TO PLAN. Clinicians have a professional obligation  to address tobacco use and can have  an important role in helping patients  plan for their quit attempts.
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ASSESSING  READINESS to QUIT STAGE 1: Not thinking about changing anytime  soon STAGE 2: Considering changing, but not yet STAGE 3: Getting ready to change soon STAGE 4: In the process of changing STAGE 5: Changed a while ago Patients differ in their readiness to quit.
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Maintenance Contemplation Action Preparation Pre- contemplation Relapse * Not ready  to quit  Assess readiness to quit (or to stay quit) at each patient contact. For most patients, quitting is a cyclical process, and their readiness to quit (or stay quit) will change over time. ASSESSING  READINESS to QUIT  (cont’d)
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Does the patient now use tobacco? Is the patient ready  to quit now? Preparation Precontemplation - or -  Contemplation Yes Yes No Did the patient once  use tobacco? Action - or - Maintenance Never smoker Yes No No IS a PATIENT READY to QUIT?
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STAGE 1: Precontemplation Not thinking about quitting in the next 6 months Some patients are aware of the need to quit. These struggle with ambivalence about change. Patients are not ready to change, yet. Pros of continued tobacco use outweigh the cons. GOAL:  Move the patient into the contemplation stage. ASSESSING  READINESS to QUIT  (cont’d)
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STAGE 1:  PRECONTEMPLATION Counseling Strategies DON’Ts Persuade “Cheerlead” Tell patient how  bad tobacco is, in  a judgmental  manner Provide a  treatment plan DOs Strongly advise to quit Provide information Ask noninvasive questions;  identify reasons for tobacco use “Envelope” Raise awareness of health  consequences/concerns Demonstrate empathy, foster  communication Leave decision up to patient
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Considering quitting in the next 6 months but  not in the next 30 days  Patients are aware of the need to quit.
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