Motivational Interviewing - Smoking
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Transcript - Motivational Interviewing - Smoking
(Music playing in the background over opening text on screen.)
Text on screen:
Prevention in Hand
Motivating Patients to Adopt a Healthier Lifestyle
(DR. SELBY walks up to the camera. He then stands alone in a hallway. We can see several doors of examining rooms in the background. He addresses the camera directly. Background music fades, then stops.)
Text on screen:
Dr. Peter Selby
Centre for Addiction and Mental Health
University of Toronto
DR. SELBY: Most people know that they shouldn’t smoke, but that doesn’t mean it’s easy to quit. And in many cases, despite knowing the health risks associated with tobacco use, some patients simply aren’t ready to stop smoking yet. In this scenario, a patient is being seen for a recurring cough. The physician is aware that the patient smokes and would like the patient to quit. However, the patient is not ready to stop. Motivational interviewing can help physicians support behaviour change. As you will see, the physician in this example uses three of the 5As - ask, advise and assist - in combination with the 5Rs - relevance, rewards, risks, roadblocks and repeat - to better understand the patient’s smoking habits. Recognizing the low level of readiness, the physician offers suggestions to gradually cut back on tobacco use.
(Background music)
Text on screen:
Addressing the Risk Factors for Chronic Disease:
Smoking
(Background music fades, then stops. A female doctor and male patient are sitting across each other, interacting in an examining room.)
DOCTOR: So, Alan, on the topic of your recurring cough, I’d like to discuss a bit about your lifestyle as it can have a link with your cough. Would you be okay with that?
PATIENT: Yeah.
Text on screen:
Ask
DOCTOR: Alright. So how may cigarettes do you smoke in a day?
PATIENT: About a pack.
DOCTOR: When you say a pack, does that go to twenty, twenty-five?
PATIENT: Twenty-five.
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Advise
DOCTOR: Alright. I have to say that as your doctor, I’m very concerned about you smoking. And I would really advise you to stop entirely as soon as possible.
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Relevance
Readiness is low
PATIENT: Look, I’m not ready to quit. And I don’t really feel like being lectured. I realize I should quit, but I’m not ready.
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Rewards
DOCTOR: I can see that you’re very upset about me talking about your smoking, and I’m very sorry because that was not my intention. But if it’s okay with you, I’d just like to get a better understanding of what you like about smoking. What is - why is it good for you?
PATIENT: Well, it helps me relax. When I’m really stressed out, it just really relaxes me.
DOCTOR: Mm-hmm. Anything else?
PATIENT: Well, my best friend and my brother smoke, and when we go out, you know, it’s something to do.
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Reflect
DOCTOR: It seems to me like it’s a very social thing for you. It’s a habit, and your friends, your family smoke.
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Risks
DOCTOR: Is there anything you can think of that you don’t like as much about smoking?
PATIENT: Yeah, my girlfriend hates it. She won’t come near me when I smoke. And, um, my Dad died from lung cancer, so there’s that.
DOCTOR: I’m very sorry to hear that. Is there anything else?
PATIENT: Coughing – the cough.
Text on screen:
Reflect
Rewards
Risks
DOCTOR: That’s right. So let me just make sure that I understand well. So, on one hand, there’s the positive things about smoking. So you’ve mentioned that it’s a social thing: you do it with your friends, it’s a habit. But on the other hand, there’s also negative effects. So there’s your girlfriend that doesn’t like it, and you’re aware of the cough being a side effect, and also your Dad unfortunately passed away from lung cancer.
PATIENT: Yeah.
DOCTOR: So based on this information, is there anything we could do that would be helpful today?
PATIENT: Well, we’ve talked about a lot. I can’t quit yet, but maybe we can work to reduce how much I smoke.
DOCTOR: Absolutely. And there is many ways available to help you do so.
PATIENT: Like what?
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Assist
DOCTOR: For example, there’s the nicotine gum. Basically, you just take one and chew it every time you get a craving. You can take up to twenty a day.
PATIENT: Alright.
DOCTOR: Mm-hmm. Would that interest you, to just get a pamphlet about more information for smokers like you who would like to reduce their smoking?
PATIENT: Yeah.
DOCTOR: Here you go. You can read about it at home.
PATIENT: Thanks.
DOCTOR: Alright. When would you like us to meet again so we can discuss this?
PATIENT: Uh, three months?
Text on screen:
Arrange
DOCTOR: Yeah, that sounds good. If there’s anything you want to discuss before that, or if you have any concerns, don’t hesitate to call our office.
PATIENT: Alright, I will. Thanks.
DOCTOR: Alright. See you next time.
(Background music up. Fade to black.)
Text on screen:
THE COLLEGE OF FAMILY PHYSICIANS OF CANADA LOGO
Production of this video was made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.