CLARK: I’m confident quitting will impact your longevity, even in such a short time frame.
JANET: Guess I didn’t realize it was that short. I always assumed it was more like ten to twenty years before it mattered, not five.
CLARK: Within a few weeks, you might see a reduction in the chest pain you’ve been having even a lower risk of heart attack.
JANET: I’ve tried quitting before, and I didn’t notice anything like that.
CLARK: Sometimes, it takes a little longer to observe the effect.
JANET: Yeah, I guess so, especially for someone who’s been smoking as long as I have.
JANET: I think I get the picture, what you mean by other benefits. Let’s just move on.
JANET: I’d like to know what these magic solutions are you think I haven’t tried, but so we’re clear, I don’t know if I’m ready to commit to anything today, or at all for that matter.
CLARK: Sure. I’ll take you through some quitting techniques we support: counselling, medications, behavioral strategies. And while they each help in different ways, we find patients have the most success when they combine the strategies.
CLARK: What strategies do you want to talk about first? They can be the ones I named, or something different.
JANET: I didn’t come in here today with a plan in mind. I only know what’s helped in the past and what definitely hasn’t.
CLARK: Which things are the ones you think might help?
JANET: Hm, I’ve quit a dozen times before, but I never follow through. So I guess anything that might help me stick with it.
CLARK: You’re not positive what’s going to help, but you’d like to explore strategies that help with follow through.
JANET: Exactly.
COACH: Asking Janet about the strategies that she prefers to discuss supports her autonomy and may increase her receptiveness to the strategies that you might share.
CLARK: What do you know about behavioral strategies for quitting?
COACH: Good choice. Continue to explore Janet’s understanding of behavioral strategies.
JANET: I don’t know nearly enough to plan any kind of strategies.
CLARK: Behavioral strategies are proactive preparations you can come up with to help you quit.
JANET: Okay, I guess that makes sense. I just feel like, I guess I thought you were going to tell me about things here or something, at least at first.
CLARK: Well, if you had to guess, what would it look like if you tried planning a specific day to quit?
JANET: I don’t know, the same as it usually does. Something stressful happens, and the pack comes right back out of the kitchen drawer.
CLARK: You normally don’t do much preparing.
JANET: I’ve never thought about preparing to quit. Like, I guess if I planned ahead, I could throw away every little cigarette hiding in all the nooks and crannies of my house.
COACH: Asking Janet to envision what would need to happen to set herself up for success allows the two of you to move in that direction, together.
CLARK: Now that we’ve talked a little about it, how do you feel about the idea of preparing to quit ahead of time?
JANET: Well it’s definitely a different strategy than I’ve heard before, you know, the usual stuff for nicotine cravings.
CLARK: In what way?
JANET: It’s not just handling symptoms. It kind of helps with the planning part too. It’s interesting; that’s all. I’ll think about it.
COACH: Good choice to ask about interest in taking steps to prepare for quitting!
CLARK: If you’re looking for continued support, I could tell you a little about counseling.
COACH: Good choice! You offered an opportunity to learn more about counseling.
CLARK: To put it in your words, someone to help you “stick with it” if you start to slip. We have resources like that.
COACH: Good choice! You offered an opportunity to learn more about counseling. Using Janet’s own words further enhanced this approach.
JANET: I remember people telling me about group therapy programs when I stopped drinking. I see the benefit, but, but I never tried it myself. It all felt too public. Not this grandma.
CLARK: I’ve known patients who had a lot of success with more private solutions like quitlines you can call and even text message.
JANET: That’s not so public, but I barely use my cell phone as it is.
CLARK: There are services that do private in person sessions as well.
JANET: Okay, that would address my issue with the group thing. Something to think about. I know a lot about counselling already, so let’s just move on.
CLARK: Fine with me.
JANET’S THOUGHT: Maybe that’s the missing thing that’ll finally work for me.
COACH: Good choice! You shared information that was tailored to Janet’s preferences and needs, which increased her receptiveness and evoked some change talk.
CLARK: You mentioned that you struggled with some withdrawal symptoms whenever you tried to quit. For that we recommend specific medications, things you mentioned trying like gums, lozenges, and patches. How did that work for you?
JANET: The short answer? It didn’t.
CLARK: What do you mean?
JANET: I’m not some schoolkid smoking clove cigarettes behind the dumpster. I smoke over a pack a day. The gum was good for a quick craving, but it didn’t get me close to the finish line.
COACH: Good! You chose to ask an open ended question (“How did that work for you?”) and Janet shared her experience with medications for withdrawal symptoms and her understanding of their potential effectiveness for her.
CLARK: Tell me more about that.
JANET: That’s all there is to tell.
CLARK: You said the gum was good for a quick craving. In what way?
JANET: I just noticed that, compared to the other times I’ve tried quitting, I didn’t. It wasn’t as extreme. You know? Like, the spikes when I needed a cigarette. It’s not like it kept me smoke free for good.
COACH: Good choice! Exploring Janet’s experience of the week she noted some benefit may help you and her build on previous success.
CLARK: Would it be okay if I shared how medications like gum work when paired with some other strategies?
JANET: Can you explain what you mean?
CLARK: Nicotine replacement products mostly work to reduce withdrawal symptoms like shakiness or irritability. The idea is to reduce those symptoms so it’s easier to follow through with other quitting strategies.
CLARK: How’s that sound?
JANET: That would have been great, but that’s not what happened.
CLARK: Maybe you weren’t getting enough nicotine. Our pharmacists could help you sort out a more effective dosage.
JANET: I’ll think about it.
JANET’S THOUGHT: Oh. Didn’t realize they’re supposed to work together.
COACH: Good job! You asked Janet’s permission to continue to share information and tailored your comments to address her needs. As a result, she expressed some interest in this option. You are making progress.
CLARK: How do you want to proceed?
JANET: Honestly, I’m still figuring it out.
JANET: To tell the truth, I wasn’t actually planning on coming back after our last visit, but my grandkids, so I asked them about it, they said they were hiding it from me. I think they look at me like I’m helpless.
CLARK: But you want to find a way to change that. Be their role model.
JANET: Yeah, I do.
JANET: In case I do decide I want to talk to the smoking person, I was wondering if you could tell me what that might look like.
CLARK: We can absolutely support you with that decision.
JANET’S THOUGHT: I just hope I follow through this time.
CLARK: I think it’s great you’re thinking about diving in right away. The planning process usually starts with setting something we call SMART goals. Can I tell you about those?
JANET: Please do.
CLARK: SMART goals are smaller benchmarks that we can set towards the bigger goal of quitting smoking. They should be specific, measurable, action oriented, realistic, and time based, smart! Basically, you want to pick something you can realistically achieve.
JANET: Like quitting permanently?
COACH: Great work! Janet appreciated that you asked for permission before sharing information about SMART goals.
CLARK: Quitting permanently is a great long term objective and challenge. For a SMART goal, we might want to consider setting something smaller and more achievable.
CLARK: How’s that sound?
JANET: Okay that sounds better. How about,
COACH: Great! You first affirmed Janet’s motivation to quit and then prompted her to think about smaller action steps. Now she has a SMART goal!
JANET: scheduling the actual meeting with the smoking person.
CLARK: That sounds perfect! When do you think you could do that?
JANET: I can probably make that happen this Friday. I don’t have any deadlines coming up or anything.
CLARK: Wonderful.
JANET: But I guess I still have a few concerns, like since my last visit, actually, I’ve noticed more than ever how smoking is a part of my daily life.
JANET: In the lead up to my show, I realized I use smoking as a sort of reward for crossing something off my list. I’ll spend hours on a single piece of art. The promise of a cigarette at the end of the tunnel motivates me to finish.
CLARK: What alternatives can you think of?
COACH: Good job putting Janet at the center of brainstorming solutions. She’ll feel more ownership of a plan she helped come up with!
JANET: Like candy instead of smoking? Great. Instead of dying of lung cancer, I’ll die of diabetes.
CLARK: It doesn’t have to be something like that.
JANET: I know, it could be something like watching TV, but that’s so “involved”. The cigarettes are easy, and they don’t pull me out of the zone.
CLARK: You want a simple smoking replacement that doesn’t change your routine.
JANET: Hm, you know a friend just gave me one of those puzzle books: crosswords, sudoku, stuff like that.
COACH: Great job responding to barriers with a reflection that prompted Janet to identify a potential solution.
JANET: It’s better than watching TV. That’s for sure. And it’ll still feel like a treat.
CLARK: Great.
CLARK: You’re working hard to take steps to better your health, and everyone here wants to support you however we can.
JANET: I’ve worked hard for fifty six years, raised two kids all on my own. I’m not afraid of a little hard work.
CLARK: It’s hard work, but it’s important work, which is why it’s so significant you came back to talk today. We’ll meet again soon to keep up with your cardiovascular health.
JANET: I appreciate it. Thanks again for everything!
COACH: After this visit, Janet spoke with a smoking cessation counselor. They discussed her preference for nicotine gum, and about going to one on one sessions. She set a quit day on her grandkids’ birthday and at her next visit she reported that she hadn’t smoked for 30 days.