February 2002 • Volume 8 • Number 2 |
By now, some of your patients may be struggling to keep their New Year's resolutions. For many patients, their goal may be to overcome addictions such as smoking.
But many people attempt quitting several times before they succeed.
So for those who have failed in their attempts at quitting, all is not lost.
Just having a conversation with their physician is motivating for patients, says FP Donald Pine, M.D. Helping patients quit smoking has become an area of interest for Pine, who practices at the Park Nicollet Clinic in Minneapolis.
Research indicates behavior change occurs in stages: precontemplation, contemplation, preparation, action and maintenance. The physician can facilitate the change process by modeling the patient encounter according to the patient's stage of change, says Pine.
Patients rarely come to him expressly to inquire about quitting smoking, he says; it emerges as an issue during the exam. That's why he keeps a flow sheet in the patient's record to detail what has transpired in regard to smoking cessation and what stage of readiness the patient is at.
Pine, whose practice has participated in trials of smoking cessation, offers this advice for patients who are ready: "The best strategy is to ask the patient to set a quit date; ordinarily we give the patient a week or so to get ready."
Pine also encourages patients to make a list of reasons to quit and work on strategies for dealing with cravings and withdrawal symptoms.
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Although studies show that patients who use nicotine replacement therapy have better outcomes, "It's surprising to me how many people choose not to use pharmacotherapy," says Pine. "They're thinking, 'Here I am trying to get rid of nicotine, and you're encouraging me to use it more.'"
But NRT helps lessen withdrawal symptoms, says Pine.
What about patients who try to gradually quit? The withdrawal symptoms will become difficult to deal with once the patient's nicotine usage significantly drops, Pine says.
"It's appealing to people to gradually reduce their use of tobacco," says Pine. "I would never discourage people from doing that, but the clinical trials show that that strategy does not seem to be effective. People need to set a date."
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.