HELPING PEOPLE STOP SMOKING

Using motivational interviewing skills

JENNIFER PERCIVALRGN. RM .RHV. FETC Counselling Dip

RCN TOBACCO POLICY ADVISOR

TOBACCO IS A SERIOUS PROBLEM

In the year 20001 in every 6 deaths worldwidewas caused by smoking

By the year 20301 in every 3 deaths worldwidewill be due to smoking

70% of these deaths will be indeveloping countries.

Source: WHO

Research has shown:

• Half of all regular smokers die prematurely:¼ in middle age (35-69)¼ in old age

• Stopping before 35 avoids most of the risks of premature death.

• Stopping smoking works.

Why should we help smokers to quit??

WORLD HEALTH ORGANIZATIONEpidemiologist Sir Richard Peto

stated:“Tobacco use is increasing.Over 100 million deaths from

tobacco will occur during the next 20 years……. and if nothing changes

there will bea billion deaths this century.”

• Reluctant and disillusioned– 83% say they would not smoke if they had their time

again– 71% want to quit

• Reasons– 61% Health– 43% Expense– 20% Addiction– 17% Disgust– 5% Social stigma

Smokers’ attitudesSmokers’ attitudes

• Chronic relapsing dependence syndrome • Smoking is use of the addictive drug nicotine• Delivered to the brain by tobacco smoke via

lungs and blood• Reinforced by sensory, behavioural and

social conditioning• Entrenched by powerful withdrawal syndrome • Great harm caused by toxins in the smoke• Promoted commercially, exempt from

consumer protection legislation

What is smoking?What is smoking?

Hospital and Health Centre Policies need to reinforce the importance of giving advice to all smokers about stoppingMost smokers want to stop, but their chances of success are low unless they are offered support and treatment.

Brief advice, pharmacotherapy's and intensive behavioural support have all been shown to increase a smoker’s chance of stopping.

Recommendations for Clinical Practice

Ask about smoking at every opportunityand update records

Advise all smokers to stop in a personalised and appropriate manner

Assess motivation to stop

Assist the smoker to stop

Arrange follow up if possible

Recommend smokers to use NRT/Zybanand provide accurate information and on treatment options

That’s all well in theory but!!!

How do you engage the reluctant smoker???

GOOD ADVICE

SMOKERS GIVE MANY REASONS FOR CONTINUNING

• Enjoyment

• Habit

• Social norm

• Ritual

• Routine

• Few mention addiction.

Charlotte Lewis

Jennifer - you mentioned that you might be able to provide some alternative cartoons which are more relevant to the renal setting? I wondered if you were still planning to do this?

Nurses Attitudes to the Topic of Smoking

Myth No.1

If I ask about my patient’s smoking habits they:

Will not like me or let me care for them

Will think I don’t understand

Will not return for their care

Will not let me into their home again

Instead of listening to your advice they can often spend quite a bit

of time justifying their smoking habit!!

Which leads you to the ‘Tennis match’ conversation

THE CHANGE PROCESS

• No-one changes their behaviour without first changing their attitudes and beliefs.

• When a patient argues with you it means you have made a wrong assumption.

• Long term behaviour change takes time

• If you lose the sense of urgency you will find opportunistic interventions much easier

The Public’s

attitude to health

advice is not always positive!!

STEPS TO QUITTING

1. Deciding

2. Preparing

3. Quitting

4. Staying stopped

5. Coping with setbacks

Current Behaviour

Giving Advice to Stop Smoking?

• Most smokers know ‘its bad for them’.

• Most can give you ‘good reasons’ why they do not want to stop right now.

• When you discuss this it often polarises them into taking a defensive position

Do you follow all the good advice you are given?

What works?

• Elicit what the smoker already knows and their interest in receiving information

• Provide information neutrally

• Elicit the smoker’s interpretation

QUESTIONS SMOKERS NEED TO CONSIDER

Why do I want to stop smoking?What is the major benefit to me?

When will I stop?

Living without my cigarettes

What will I do when I want a cigarette?What happened last time I failed to stop smoking?

How will I avoid this happening this time?

The day I stop smoking

What will I do to prepare?Am I prepared to STOP, not cut down?

After I stop smoking

What will I spend the money on?What will be better about my life without cigarettes?

RELAPSEWhy do smokers fail to quit?

• Stopping under pressure from someone else

• Lack of personal motivation

• Attaching insufficient importance to stopping

• Withdrawal symptoms

• Poor timing

• A question of self-image

• “I thought `just one’ wouldn’t hurt”

People succeed when they:

• Invest time and thought in quitting

• Want to stop and know what to expect when they do

• Have enough information and have developed coping strategies

• Can plan ahead for difficult or unexpected situations

• Have encouragement from others

• Can see themselves as non-smokers

Stopping Smoking - Not ready!

• Respect this decision

• Ask: What would need to be different for you to consider change?

• Explain your own concern

• Leave the door open for future discussions

Unsure about change?

• Examine the pros and cons

• Understand ambivalence

• Explore concerns

Instead help smokers weight up the pros and cons

Making Changes

A change I’d like to make:

The Advantages of

The Disadvantages of

Current behaviour

Making

the Change

Take into consideration: Consequences to self Consequences to others

How I feel about myself How others feel about me

My Conclusion / Decision / Goal:

Self-efficacy: a belief in one’s own

ability to achieve change

• Normally, people only attempt things which they feel they succeed at

It’s important to make an assessment of their Motivation and Confidence to change

Building confidence

• Ask: What did you learn from previous stop smoking attempts? What works and what doesn’t work?

• Ask: What Do you know of anything that has worked for other people?

• Theses question can help the smoker develop a plan of action

Key aspects of Motivational interviewing

• Express acceptance and affirmation

• Ask questions to understand how they see the problem Use reflective listening skills

• Elicit and reinforce self-motivational statements: concerns, desire, intention and ability to change

• Assess and feedback their readiness to change

• Affirm their freedom of choice

Basic principles of motivational interviewing

• Avoid making pressure to change: this will create resistance. You can never win and, in the process, may lose the chance to help

• Roll with any resistance: do not argue with the patient if they say their action is not harmful. Instead, respectfully clarify their own thoughts or views

• Support the patient’s self-confidence: look for the positive aspects and build on them

In summary changing the conversation helps

From A tennis match

Telling them why they should change

Counter arguments /

Justification

The patient thinks …

‘You don’t understand’

Collusion /

Resistance to change

Denial

To Self re-evaluation

Giving personally relevant facts

Time to analyse their own motivation and confidence

‘I can see the effect on me.’`Believing I have the power to change.’

Movement through the cycle of change

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