By Sue Cody
What are the best practices to assist smokers to quit tobacco? It’s a big question, that got some big answers when the Columbia Pacific Coordinated Care Organization (CCO) brought experts to Astoria for The Big Quit presentation Jan. 18. Another presentation will be held from 6 to 8 p.m. Feb. 15 at Tillamook Bay Community College.
Health care professionals gathered at Clatsop Community College and enjoyed an interactive session on clinical assisted tobacco cessation. With 39 percent of CCO members smoking cigarettes, it is important to remind them quitting is the No. 1 thing you can do for your health, says pharmacist Melissa Brewster.
Because of the physiological dependence and behavioral aspect of smoking, a combination of counseling with nicotine replacement therapy or medication aids is the most effective treatment for long-term success in smoking cessation.
Clinicians make a difference
“Providers make a big difference,” says Andrew Huff, behavioral health innovation specialist. “Intervention does matter.”
A quick way to remember is to: Ask, Advise, Refer.
Providers who continually ask patients about tobacco use have a positive effect on their journey toward quitting. It is important to ask about usage each time in a nonjudgmental way, says Maranda Varsik, primary care innovation specialist.
Advise patients to quit because smoking is harmful. Clinicians can help motivate smokers to quit by showing empathy. For instance, it is helpful to say something, like “I know it’s hard, but I am here for you,” Varsik says.
You have resources, you are there to provide them with tools, she says. Suggest using the Oregon Quit Line, 800-QUIT NOW. It offers free support for tobacco cessation. Smokers can enroll in Quit for Life, which offers free phone support and four personalized sessions along with two weeks of nicotine replacement therapy. It has a 30 percent success rate, Varsik says.
Paul Carson led a discussion on motivational interviewing. “It is a collaborative conversation style for strengthening a person’s own motivation and commitment to change,” he says.
Sometimes the provider is intimidating, especially for those with trauma in their background, Carson says. It is important to let them have an equal voice.
People know smoking is bad for them. The idea of quitting is inside them – it is a seed you want to put water on, Carson says. “Sit on your super powers and act as navigator to guide them to what they already know. Patients are the experts on their own lives.”
Carson suggests an acronym: OARS, to unlock a person’s internal motivation. He offers sample statements.
O: Open-ended questions: Avoid questions that lead to yes and no answers. Open conversations with questions, such as, “What would it be like if you weren’t a smoker? What would be the advantages of quitting? Would it help in your relationships?”
A: Affirmations: “I appreciate your honesty that you don’t want to give up cigarettes. It took a lot of courage to cut back. You really care about your family.”
R: Reflections: This is another way to connect and let them know you are caring. Repeat what someone said, so they feel understood. “You’ve got some concerns, it sounds like it is challenging for you to make that change.” Feel like someone heard you.
S: Summaries: A summary reflects what the patient said and reinforces that you are listening. “I heard you say you love smoking, but your girlfriend doesn’t like it. You don’t want a disease, like your friend.”
Huff guided participants in role playing where partners took turns being a patient and a clinician, following a general outline of the patient’s background. Conversation afterward showed the challenges and effective strategies.
Brewster says nicotine is the addictive agent in cigarettes, but it is the chemicals that are harmful. She emphasized the effect of counseling along with nicotine replacement therapy or medication.
It is best to use a combination of long-acting (patch) and short-acting (gum, lozenge) nicotine replacements.
She detailed different kinds of medications and cautioned about interactions and contraindications.
The Columbia Pacific CCO covers 26 weeks of nicotine replacement therapy for patches, gum and lozenges, and three months of treatment with drugs like Wellbutrin and Chantix.
For more information on clinical assisted tobacco cessation, go to http://rxforchange.ucsf.edu/
Sessions of "The Big Quit" are currently being scheduled for Tillamook and Columbia counties.