Quitting smoking is the hardest thing many people will ever try to do in their lives, and most of them have to make multiple attempts before they are successful.
Ensuring these smokers don’t lose hope during the prolonged journey toward tobacco freedom can be hard for clinicians like respiratory therapists. Two RTs who specialize in tobacco treatment offer some tips for keeping patients engaged with the quitting process.
You are not alone
Cara DeNunzio, MPH, RRT, CTTS, AE-C, says the first order of business when working with patients who have tried and tried again with no success is to assure them they are not alone.
“Informing patients that smokers often make several quit attempts — often as many as seven — before they permanently quit smoking, helps give them the confidence that they can be successful, and they shouldn’t give up after one try,” said DeNunzio, an RT at Tidelands Health in Murrells Inlet, SC.
She finds patients are often surprised to hear how difficult it really is to kick the habit and they feel better knowing others have struggled through quit attempt after quit attempt and emerged smoke-free at the end.
“This method may instill confidence in the patient that feels defeated and upset at their initial failure to quit successfully and may be more motivating at this point than a ‘health scare’ type of approach,” DeNunzio said.
Meggan Gates, BS, RRT, TTS, a COPD educator at Trinity Hospital in Mohall, ND, offers her patients plenty of positive reinforcement whether they actually quit or not.
“It takes many attempts to quit,” Gates said. “I tell my clients to think of your first failed attempt as a success because you tried. Then I tell them to contact me and we will re-evaluate what triggers made them go back to smoking and how to approach their next quit attempt.”
She believes this approach makes them realize that one attempt usually isn’t enough, and that is just fine.
“Cutting back further and also attempting again to quit is better than smoking the two packs a day that they had been doing,” Gates said.
Assess for addiction
Both therapists say there is much an RT can do to keep people engaged in the stop smoking process, even when they’ve already made several attempts that failed.
According to DeNunzio, step one is making sure they have been assessed for their level of nicotine addiction, which she says can easily be accomplished by having them take the Fagerstrom Test, a quick bedside quiz resulting in a score from 0 to 10. Anyone who scores 5-10 is considered to have a fairly high addiction and could probably benefit from medication to help them quit.
Some patients don’t even know medications are available and hearing that there are seven FDA approved products on the market — bupropion, Chantix, and the nicotine patch, gum, lozenge, inhaler, and nasal spray — may pique their interest in learning more.
Realizing there are drugs that can help can also open the door to a discussion about the behavioral factors associated with smoking and strategies that can help overcome them, such as not going outside with coworkers during breaks if those coworkers will be smoking.
For patients who have tried medications before, DeNunzio says it’s important to go over instructions for use, because often patients who have failed to quit weren’t following the directions and thus weren’t getting as much benefit from the medications as possible.
“When explored through discussion, each quit attempt becomes a learning opportunity for the patient to be able to identify where they may have gone wrong and plan to make changes for future successful quit attempts,” DeNunzio said.
It’s not easy
Gates believes RTs should acknowledge the fact that people who have tried to quit and failed may need a different approach, especially those who have exhausted all forms of over-the-counter nicotine replacement products and have taken part in counseling.
Those patients could benefit from adding bupropion or varenicline to the treatment plan.
“My advice to fellow RTs is, don’t let your patient feel discouraged. Remind them that every quit attempt is a success because they are one step closer to getting rid of the very thing that is making them sick,” Gates said.
Just be sure to keep the conversation positive.
“Don’t tell them how bad smoking is for them and what can happen to them — they already know the statistics,” Gates said.
Gates says letting yourself stray into negativity will only break the rapport you have worked hard to build with your smoking patient.
“They need someone to listen to them and hear what their struggles and triggers are,” Gates said. “Be empathetic with them — it’s not easy to quit smoking.”
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