HELPING PEOPLE STOP SMOKING Using motivational interviewing skills

HELPING PEOPLE STOP SMOKING Using motivational interviewing skills JENNIFER PERCIVAL RGN. RM. RHV. FETC Counselling Dip RCN TOBACCO POLICY ADVISOR

TOBACCO IS A SERIOUS PROBLEM In the year 2000 1 in every 6 deaths worldwide was caused by smoking By the year 2030 1 in every 3 deaths worldwide will be due to smoking 70% of these deaths will be in developing countries. Source: WHO

Why should we help smokers to quit? ? WORLD HEALTH ORGANIZATION Epidemiologist 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 be a billion deaths this century. ” 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.

Smokers’ attitudes • 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

What is smoking? • 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

Hospital and Health Centre Policies need to reinforce the importance of giving advice to all smokers about stopping Most 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 opportunity and 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/Zyban and 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.

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?

RELAPSE Why 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

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 Telling them why they should change A tennis match Counter arguments / Justification To Giving personally relevant facts The patient thinks … ‘You don’t understand’ Collusion / Resistance to change Denial Self re-evaluation 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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