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: 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?

3 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 client’s motivation to become a non- smoker waning? What specific obstacles are likely to arise in the future? Has this quit attempt failed?

5 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?

6 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?

7 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?

8 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?

9 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?