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Role of Smoking Counselling& Cessation Counsellor and sharing of experience on anti – smoking services

Wu Man Ying Winnie

APN (FM & GOPC) /NDH

2007

Learning Objectives

1. Understand the background and services of Smoking Counselling & Cessation Clinic

2. Recognize the role of Smoking Counselling & Cessation Counsellor

3. Identify patients for referral to SCCC

Background

Since May 2002, HAHO had initiated the Smoking Counselling and Cessation Program (SCCP) in 10 Smoking Counselling and Cessation Centres(SCCCs 無煙 新天地) including fivehospitals and five General Out-patientClinics

Locations of SCCC(May 2002)Hong Kong IslandPamela Youde NethersoleEastern HospitalSai Ying Pun Jockey Club GOPC

Kowloon RegionPrincess Margaret Hospital SOPCQueen Elizabeth HospitalOur Lady of Maryknoll HospitalCheung Sha Wan Jockey Club GOPCTseung Kwan O Jockey Club GOPC

New TerritoriesNorth District HospitalTuen Mun Hospital, Ambulatory Care Centre

Tuen Mun Yan Oi Polyclinic

Background( Cont’d)

Till now the number of SCCCs has increased to 30 including 16 full-time & 14 part-time hospitals/ GOPCs

In the past few years, a total of about 200 smoking cessation counsellors have been trained by IANS

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HAHO Quitline 2300 7272

The statistics of Smoking Counselling & Cessation Centres (May 2002-April 2007)

Number of new cases: 17,000

Average success quit rate at 1 month62.5% (2002)68.3% (2003)76.2% (2004)75.3% (2005)75.0% (2006)

Role modelIndividual CounsellingMotivate and encourage smokers to have Smoking CessationHelp smokers to overcome barriersProvide pharmacological and behavioral change therapyTelephone follow up counsellingPrevent relapse of smoking

Role of Smoking Cessation Counsellor

1st visit : Face to face counselling2 week : Telephone counselling

1 month : Face to face counselling

3 month, 6 month, 1 year : Face to face counselling or telephone couselling

Monitor client’s progress as follows

Monitor vital signs, body weight, body height, BMIAssess smoker’s smoking history: e.g. daily smoke consumption of cigarettes, smoking habit & quit history and etcIdentify and assess the smoker of readiness to quitAssess the smoker’s nicotine dependence level by using Fagerstrom Test

Total score may vary from 0 to 10Score 0-3 : low nicotine dependenceScore 4-5 : moderate nicotine dependenceScore 6-10 : high nicotine dependence

At First Visit (Face to face counselling)

Assess the smoker’s stages for change (Pre-contemplation, contemplation, preparation, action & maintenance)Review the smoker’s medical history, surgical history, psycho- social history and etcMeasure CO level by using CO monitor

At First Visit (Cont’d)

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At First Visit (Cont’d)

Motivate the smoker to quit

Educate the smoker about the effects/ hazards of smoking

Educate the smoker about the benefits of smoking cessation

Set a quit date

Identify and develop plans to avoid triggers

At First Visit (Cont’d)Skills training: help smokers to overcome barriers associated with cessation, such as nicotine withdrawal symptoms, depression and weight gain. and coping skills, behavior therapy, weight control and using ‘5D’ to deal with cravings

‘ 5D ’ : DeclareDelayDeep breathing Drink more waterDistract yourself

At First Visit (Cont’d)

Recommend nicotine replacement therapy (NRT). Educate the client how to use NRT, dosage, duration of therapy and adverse reactionEncourage smokers express their fears and difficultiesGain support for smoker from spouse, family members and friendsArrange follow up

1 week telephone counselling

Ask about :The smoker’s smoking statusThe difficulties while quittingThe use of NRTAny signs of nicotine withdrawal symptomsRepeat the coping skillsProvide support, concern and encouragement

1 month follow up ( prefer face to face counselling )

Check vital signs: BP, pulse, BWMeasure CO level by using CO monitorAsk about the smoking status, side effect of NRTEncourage the quitter to report perceived benefits form stopped smokingProvide skills in maintenance and prevention of relapse

1 month follow upFor smoker- reinforce smoker’s decision to quit- review the benefits for quitting- assist the smoker to anticipate the problems during quitting Encourage diet control & exercise to prevent gaining body weightGive support, concern and encouragement Including : successful award certificate and souvenirArrange follow up

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3 month, 6 month, 1year follow up (telephone or face- to- face counselling)

Ask about the smoking statusEncourage the quitter to report the benefits of quitting Avoid triggersProvide skills in maintenance and prevention of relapseFor smoker- Reinforce smoker’s decision to quit - Review the benefits of quitting- Assist the smoker in solving problems during quitting

3 month, 6 month, 1year follow up( telephone or face- to- face counselling)

Provide support , concern and encouragement & including souvenir

Arrange follow up

Suggest and encourage the quitters to share the quitting process to smokers

Health benefits of quitting smoking20 mins

BP/P normal, circulation improves8 hrs

． CO level in blood drops to normal rate． O2 level in blood increases to normal

24 hrs Chance of heart attack decreases

48 hrs Nicotine not detectable, taste and smell improved

Health benefits of quitting smoking

72 hrs Breathing easier, energy increases

2-12 wks Circulation improves, walking easier

1-9 months ．Coughing, sinus congestions, fatigue

and SOB all decrease．Body’s overall energy level increases

Health benefits of quitting smoking

1 yearHeart disease death rate is halfway back to that of a nonsmoker

10 year．Ca lung death rate drops almost to the

rate of nonsmokers．Incidence of other cancers decreases

( College of Nursing at Ohio State , 2002)

Nicotine Replacement Therapy (NRT)

Nicotine Patch

Nicotine Gum

Nicotine Inhaler

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Consult Medical Advisor for the following conditions

Severe cardiovascular diseaseUnstable anginaHyperthyroidism

Diabetes MellitusUncontrolled hypertension

Client aged < 18 years old

Professionals from own affiliated hospital e.g. In-patient, SOPD, para-medical staff such as dietian, physiotherapist and etc

Self-enrolment through NDH Quitline(2929 1080) or HAHO Quitline (2300 7272)

Walk-in

Sources of Referrals

SCCC / NDH Sources of ReferralApril 2006 – 31 March 2007)

27.1%

56.6%

2% 0%

6.1%8.2%

0%

10%

20%

30%

40%

50%

60%

Per

cent

age

of r

efer

ral

In-patient SOPD Other dept. NTEC Cluster Quitline Walk-in

Waiting time of the referrals

Stat or as soon as possible if medical condition needed

1 day later

Usually within 1 month

Difficulties / Problems encountered

Withdrawal symptomsMisunderstanding about the complications after quitting smoking Weight gainNo concept of the harmful effect of smoking to the healthNot supported by relatives (e.g. old aged)Poor social or psychological supportDenial

Help our patients stop smoking Today!!!