TABLE 3

Counseling Approaches

CEASE program: Ask, Assist, Refer114,188
 Ask. Does your child live with anyone who uses tobacco?
 Assist. Assist families to stop using tobacco and eliminating tobacco smoke exposure. This assistance includes both counseling and recommendations or prescriptions for medication
 Refer. Refer families who use tobacco for outside help, such as the state or national telephonic quitline (1-800-QUIT-NOW in the United States)
American College of Chest Physicians Tobacco Dependence Treatment ToolKit: Assess, Recommend, Monitor, Revise103
 Assess and diagnose
 Recommend a treatment plan. The treatment plan should be based on the level of nicotine dependence, with more dependent patients needing more aggressive therapy
 Monitor the treatment plan’s outcome
 Revise the treatment plan to improve effectiveness and minimize adverse effects. Base effectiveness on achieving control of nicotine withdrawal
ASKNOW: A Stage of Change theory–based counseling strategy189
 Assess the health behavior
 Determine the stage of change
 Keep in mind key facts
 Jointly negotiate an action plan
 Observe outcome in follow-up
 Work toward the next stage
Stage of Change theory of health behavior change103,190
 Precontemplation—Patient has no intention of changing behavior
  Stage-matched interventions include:
  1. Assess roadblocks to the proposed change
  2. Discuss the relevance, risks, and rewards of the proposed change
  3. Determine what action the patient and/or family is willing to take
Contemplation—Patient intends to make the behavior change within the next 6 mo but makes no commitment to action
  Stage-matched interventions include:
  1. Assess roadblocks, including level of nicotine dependence
  2. Assess opportunities to overcome roadblocks
  3. Recommend appropriate pharmacotherapy
  4. Build confidence that the patient can make a change that has beneficial results
Preparation—The intention is to implement the behavior change soon, within 1 month
  Stage-matched interventions include:
  1. Assess the specific changes needed
  2. Recommend and/or prescribe appropriate pharmacotherapy
  3. Facilitate the development of specific plans for smoking cessation
Action—Patient has made the behavior change recently (within the past 6 mo); relapse risk is at its highest
  Stage-matched interventions:
  1. Monitor for difficulties and lapses
  2. Discuss strategies to recover from them
  a. Consider if treatment plan needs modification
  3. Discuss how to handle difficult situation
  4. Provide positive reinforcement
Maintenance—Six months to life postchange; the risk of relapse is still present, although not as high
  Stage-matched interventions:
  1. Ask about lapses and temptations to lapse
  2. If nicotine withdrawal symptoms are in good control, consider if pharmacotherapy can be stepped down
  • CEASE, Clinical Effort Against Secondhand Smoke Exposure.