TOBACCO TRIGGER TAPE SYNOPSES - CARDIOLOGY Tape
Dialogue
Scenario
Problem
Solution
6
“Well, we all have to die of something! So what if I lose a couple of years at the end of my life from smoking?”
Man is lying on a patient examination table, talking with his clinician.
Smokers who make this statement think that they will simply fall over one day and die in an instant. They forget that smoking-related illness can create years of miserable pain and suffering.
Shift the focus from dying, as this is not about dying. Rather, it is about living with the very real long-term effects of smoking. Ask the patient, “What would it be like to lie in bed for years as a result of a stroke or to not be able to walk up two or three steps because of emphysema? Could you live this way?” Say, “If you continue to smoke, you significantly increase the chances of something like this happening to you!” Educate the patient about years of life lost due to smoking, such as by saying, “The average smoker loses about 7 years of life because of smoking. What do you get from smoking that is so important that you are willing to give up that much of your life?”
12
“I’d like to quit smoking, but it’s probably too late for me. I’m sure the damage has already been done.”
Man is sitting on a patient examination table, talking with his clinician.
Many individuals over age 40 think that the damage done to the body from smoking is beyond repair. They think, What’s the point of quitting?
Advise the patient that it is never too late to quit smoking. Explain that many of the positive physical changes that occur as a result of quitting happen within weeks or months and, further, research shows that even people in their 70s and 80s benefit from quitting. Remind the patient that even if someone has a smoking-related illness, quitting can reduce the rate of disease exacerbation.
19
“Aren’t I just trading one addiction for another if I use the gum or the patch?”
Clinician’s office
Many smokers think that NRT products are as addicting as smoking.
Help the patient understand that the nicotine in all forms of nicotine replacement therapy is delivered to the body in a much different way than it is from smoking. Nicotine from smoking reaches the brain in 11 seconds. All forms of NRT take between five minutes to six hours to reach peak concentrations. It is the speed at which the nicotine from smoking reaches the brain that promotes addiction. Additionally, NRT provides much lower levels of nicotine than does smoking. Because the NRT products deliver much lower amounts of nicotine at a much slower rate than smoking, they have very low addictive potential. Remind the patient that using NRT doubles ones chances of quitting successfully and that it is only to be used for a short period to time.
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Copyright © 1999-2011 The Regents of the University of California. All rights reserved.
TOBACCO TRIGGER TAPE SYNOPSES (CONT’D) Tape
Dialogue
26
“I get up every morning at 5AM and work out. So what’s the big deal if I smoke a few cigarettes a day?”
31
Problem
Solution
N/A
There is a belief that exercise, especially aerobic type workouts, will mitigate the negative effects of smoking.
Exercise, no matter what type, does not negate the effects of smoking. In fact, remind this individual that continued smoking will negatively impact their ability to exercise by damaging the lungs and reducing available oxygen. Almost all individuals start out as intermittent smokers and quickly become everyday smokers as a result of the addictive nature of nicotine. Very few people can “control” their smoking.
“My dad just had a minor heart attack...he doesn’t smoke, but my mother does. Can that be causing his heart problems?”
Community pharmacy
There are many misconceptions about the effects of second-hand smoke.
Exposure of adults to second-hand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer. It is best that this patient not be exposed to tobacco smoke during or beyond recovery. Suggest a meeting with the family and strategize about how to minimize his exposure to second-hand smoke.
32
“I’m bartender…what’s the point in quitting when I’m around smoke all the time?”
N/A
Some patients believe that secondhand smoke is just as toxic as smoke inhaled directly from the cigarette.
Although exposure to second hand smoke has it’s own set of risks, current evidence shows that smoking is much more detrimental. Quitting active smoking is still worthwhile even if you are often in a smoky environment. If this person is concerned about being triggered to smoke by seeing others smoking, create a coping plan to specifically deal wit this situation. Here are some coping techniques you could suggest to this patient: Before going to work visualize yourself doing a good job, yourself and being able to cope with other people smoking. Then see someone offer you a cigarette and you respond by saying, “No thanks, I don’t smoke.” Plan “fresh air” breaks every hour or so. Use an oral form of NRT so that you can dose yourself more often while at work. Have a support person at the bar with whom you can talk as needed.
37
“Smoking helps me deal with stress.”
N/A
Patients mistakenly attribute relief of withdrawal symptoms
Help the patient understand that smoking does not get rid of stress, it causes it. Because there is no drug in cigarettes that magically gets rid of stress, remind the patient that they have actually been the one to deal with their stress for their entire life. Advise the patient to give themselves credit for successful stress management, not the cigarette. Provide patients with handouts that explain the real relationship between smoking and stress. Refer patients to local stress management programs, advise them to begin to exercise, or suggest that they take a meditation class, all ways to effectively learn to deal with stress.
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Scenario
Copyright © 1999-2011 The Regents of the University of California. All rights reserved.
TOBACCO TRIGGER TAPE SYNOPSES (CONT’D) Tape
40
Dialogue “What are you talkin’ about…my grandfather, he lived to be 95 years old. Smoked cigarettes from 1925 until he died. That’s over 70 years that he lived, smoking a cigarette – at least 2 packs, every day – get outta here…!”
Page 3 of 3
Scenario Examination room
Problem
Solution
Many smokers under-estimate their risk of tobacco-related disease.
Point out to the patient that for every person in their 70s or 80s who smokes and does not have any apparent ill health effects, there is someone in their 20s or 30s who already suffers from emphysema, has been diagnosed with cancer, or has had their first heart attack. Use personal stories of young patients you have encountered who have had smoking-related illnesses to illustrate this point. Help the patient understand that there is no scientific way to know which group they will fall into. Remind them that smoking is very risky, and the vast majority of smokers develop serious health problems as a result of their smoking. Focus the patient on how these potential health effects could negatively impact their ability to engage in favorite activities.
Copyright © 1999-2011 The Regents of the University of California. All rights reserved.
