Case studies in smoking cessation

1
Case studies in smoking cessation

• Robert West
• University College London
• Rio de Janeiro
• November 2006

2
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
• What is a realistic goal for the consultation?
• What factual information do you need to get from
  the patient to help decide the best way of
  achieving that goal?
• What do you need to know about the patients
  personality, goals and state of mind to help you
  decide the best way of achieving the goal of the
  consultation?

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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?

4
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 clients motivation to become a non-smoker
  waning?
• What specific obstacles are likely to arise in
  the future?
• Has this quit attempt failed?

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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?

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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
  dont usually smoke until the evenings, but then
  I smoke a lot, especially when I am out with
  friends
• What do you say next?

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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?