Case studies in smoking cessation
Robert West
University College London
Rio de Janeiro
November 2006
1
Scenario
•
•
•
You are a smoking cessation advisor paid to help
smokers to stop.
Each case involves the beginning of a consultation with
a client or patient who has made an appointment to see
you.
Things to consider:
1. What is a realistic goal for the consultation?
2. What factual information do you need to get from the patient to
help decide the best way of achieving that goal?
3. What do you need to know about the patient’s personality, goals
and state of mind to help you decide the best way of achieving
the goal of the consultation?
2
Things you need to establish in a
preliminary consultation
• Does the client actually WANT to become
a non-smoker and all that that entails?
• What style of interaction will work best with
this client?
• What type and how much medication will
the client need?
• What can be done in the consultation to
help the client overcome specific obstacles
they will encounter?
3
Things you will need to establish
in a follow-up consultation
• Has the client smoked at all and if so in
what circumstances?
• Is the client struggling mentally and if so
when and in what way?
• Is the client’s motivation to become a nonsmoker waning?
• What specific obstacles are likely to arise
in the future?
• Has this quit attempt failed?
4
Case 1:
• Middle-aged female overweight smoker
advised to come and see you by her GP
• You: ‘How can I help you?’
• Patient: ‘I was told to come and see you
by my doctor because he says I have to
stop smoking. I have tried in the past but I
always put on weight.’
• What do you say next?
5
Case 2:
• Young man comes to see you because he
has heard about your clinic from a friend
• You: ‘How can I help you?’
• Patient: ‘I want help with stopping
smoking. I don’t usually smoke until the
evenings, but then I smoke a lot,
especially when I am out with friends’
• What do you say next?
6
Case 3:
• A middle-aged man who has been coming to
your clinic for 3 weeks. He has been using the
nicotine patch. Every time he comes back he
reports that he has had one or two cigarettes in
the past week
• You: ‘How has it been this past week?’
• Patient: ‘I feel that I am doing very well but I did
have a cigarette yesterday when I was out
drinking with friends’
• What do you say next?
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Case 4:
• A married couple make an appointment to
see you having heard about your clinic
from a friend
• You: ‘How can I help you?’
• Woman: ‘We want to stop smoking and
have heard that you may be able to help
us. We have both tried many times before
but never lasted more than a few days’
• What do you say next?
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Case 5:
• An elderly man comes to see you because
he has been told to by his GP. He has
advanced obstructive airways disease and
smokes heavily.
• You: ‘How can I help you?’
• Patient: ‘My doctor said I should come
and see you because I need to stop
smoking.’
• What do you say next?
9