11 INSTRUCTOR GUIDELINES

Transcription

1 STAGE: Recent Quitter Ms. Barnes is a 28-year-old woman who has been filling her oral contraceptive prescription at your pharmacy for the past 6 years. Four months ago, you assisted her in quitting smoking using nicotine gum. At the time, she was changing jobs from restaurant waitress to flight attendant and was hoping to stop taking the oral contraceptive pills to plan for a pregnancy. You have not seen Ms. Barnes since then, so today you are calling to follow-up on the previous counseling session. KEY POINTS THIS PATIENT is a previous cigarette smoker who quit smoking 4 months ago using nicotine gum is continuing to use nicotine gum (1 4 pieces per day) beyond the recommended treatment duration (12 weeks) is planning to become pregnant in the near future THE PHARMACIST congratulates the patient on her success advises the patient to discontinue use of the gum (educates her on risks of nicotine to fetus) reviews the patient s temptations to smoke and helps her develop strategies to prevent relapse arranges additional follow-up counseling Rev CASE 11 Page 1 of 6

2 Step 1: ASK Hi Ms. Barnes, this is [state your name] calling from [insert name] pharmacy I m calling to check in with you, to see how you are doing with your plan to quit smoking. I haven t smoked in 4 months! Well, except for one cigarette part of one, really in the first week. My friend put me straight and snatched the cigarette from me. Haven t smoked a puff since then. That s excellent news! Congratulations. And I m really glad to see that you were able to survive that little slip. That s a great friend you have! Step 2: ADVISE Not applicable. The patient has already quit. Step 3: ASSESS This patient is a recent quitter. Step 4: ASSIST Assess tobacco use history Not applicable. This was done at a previous assessment. It is important to address the patient s use of the nicotine gum in the current quit attempt. Evaluate current quit attempt When we last spoke, you were starting your nicotine gum regimen. Tell me how it went. Rev CASE 11 Page 2 of 6

3 I couldn t have quit without the gum. It worked so well! In fact, I m still using a little bit of it. I haven t quite gotten the courage to stop it completely. How much gum are you using now? When I first started, I followed the directions to a tee for the first 12 weeks. Now I chew somewhere between one and four pieces a day. It really depends on my work schedule. Basically I make sure I ve got gum available all the time, but I try not to chew it very often. It makes me nervous not to have some in my purse. I carry it around, just in case. I don t want to slip up again and have a cigarette instead. Treatment beyond 12 weeks is not recommended unless the patient continues to experience withdrawal symptoms. Discuss key issues: reasons/motivation for wanting to avoid relapse What s kept you from going back to smoking? My husband and I are getting ready to start a family. Now that I ve quit smoking, I want to take this opportunity to get pregnant. I stopped taking my birth control pills about a month ago. Plus, I really want to ditch the image of being a smoker it s kind of disgusting, you know? I ve been embarrassed about my smoking for so long I don t know why it took me so long to finally quit. Discuss key issues: confidence in ability to avoid relapse Those are both good reasons not to smoke. And not smoking will be particularly important if you are trying to get pregnant given that smoking can reduce a woman s ability to conceive. How confident are you that you can stay off of cigarettes? Rev CASE 11 Page 3 of 6

4 You know, I really think I can do it this time. There are times when I m working that it s tough. Like when I have a long layover in another city. Most of the other members of my crew like to go out to bars after dinner, and quite a few of them smoke. When I m surrounded by alcohol and smoke, I do get tempted. But if I m going to get pregnant, I won t be drinking anyhow. Discuss key issues: social support for quitting How do your family and friends feel about you quitting? Are they supportive? My husband s never smoked, so he s very supportive. Honestly, I m just glad that he doesn t have to smell my smoke in the house anymore. Your idea of making our house smoke-free really helped! And I ve met new friends through my job there are a lot who don t smoke. Discuss key issues: concerns about weight gain Have you gained any weight since quitting? Yes, I ve gained some weight which bothers me. But I ve only gained about 5 pounds. Honestly, I thought I d gain more than that. I think chewing the gum keeps me from eating junk food. That s one of the reasons why I still use it. I really want to lose the weight before I get pregnant. Discuss key issues: concerns about withdrawal symptoms How bad were your withdrawal symptoms? Are you continuing to experience any? I was really irritable at first, but not so much any more. My fuse isn t quite as short as it was. Rev CASE 11 Page 4 of 6

5 Facilitate quitting process: discuss coping strategies Tell me how you ve been dealing with temptations to smoke. Well, I try to avoid trips having long layovers. But I can t always pick which flights I m on. I m also trying to socialize more with the crew members who don t smoke. Facilitate quitting process: provide medication counseling Ms. Barnes, I m really happy that you ve come this far. It s a huge success. Now that you ve stopped taking your birth control pills, we need to work on getting you off of the nicotine gum because it could be harmful to your developing baby. We want you to have a healthy pregnancy and a healthy baby. Yeah, I know I should quit chewing the gum. I think it s become somewhat of a crutch for me. Is there a good way to stop? How do people do it? Well, the good news is that you aren t using much of it only a few pieces a day. What we ll do is wean you off the gum over the next few weeks. Here are some strategies to help you: Behavioral Coping Strategies: Try substituting ordinary sugar-free chewing gum for some of the nicotine pieces. Try a different oral substitute such as sugar-free candy or toothpicks. Cognitive Coping Strategies: When you feel the urge to smoke take several deep breaths. Remember why you are quitting smoking. Keep in mind, these urges will be brief. When you have long layovers use the time to: Mentally make a to-do list for the next few days. Plan in your head how you would like your baby s room to look. Be creative. Tell yourself, I don t need a cigarette to fill up time. I can do lots of other things. Then, get busy!! Now that you ve been quit for 4 months, start to see yourself as a successful, happy nonsmoker. Rev CASE 11 Page 5 of 6

6 Facilitate quitting process: offer to assist throughout the quit attempt You ve done a great job staying away from smoking and especially resisting temptations. I think your desire to have a healthy baby will allow you to stay strong in your decision to remain smoke-free. But remember that quitting is a process. There will be times when you are tempted, so please be wary of those situations, and avoid them when you can. I d like to continue to help you through this, so if for any reason you slip or experience difficulty overcoming the temptations, please give me a call. Step 5: ARRANGE Let s touch base again in about 6 weeks I ll give you a call so we can be sure that you are safely off of the nicotine gum. In the meantime, if you have any questions, or if you d like to spend some time talking about weight maintenance, let me know. I think that with a little exercise and some careful observation of your dietary intake, you could continue to maintain your current weight and maybe even lose those few extra pounds before you get pregnant. Rev CASE 11 Page 6 of 6