How to have conversations with patients about stopping smoking


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By Costanza Pearce
Reporter

30 Sep 2019

With Stoptober kicking off tomorrow, contractor Terry Maguire shares his top tips for broaching smoking cessation with patients

Stoptober, the annual 28-day smoking cessation campaign from Public Health England (PHE), is almost upon us.

The campaign, which this year will run for the entire month of October, is one of six campaigns that contractors are required to participate in as part of the community pharmacy contractual framework.

Belfast contractor Terry Maguire, who first developed a smoking cessation programme in the 1990s, answers your questions about talking to patients about quitting.

 

How should I approach the subject?

‘The subject is best approached in an indirect way. This usually means associating the interaction with the particular request the patient has. For example, if the patient is asking for something for a chesty cough, in my opinion there’s an ethical responsibility for pharmacists to ask about smoking.

‘You also get the opportunity [to bring up smoking] when advising people on the proper use of medicines. A more technical way is through a medicines use review (MUR) – MURs are going to stop in the near future in England but they do present an opportunity.

‘It’s really just getting the context right to raise awareness of and link to asking about smoking.’

 

What if I get a negative response?

‘The response of the individual is vitally important because the pharmacist needs to gage it. That’s where a little bit of training is needed. If you can observe the individual, you will know that the smoker is either resistant to change – that could be in the form of a very snappy response or ‘none of your business’, at which stage you back off – but if they’re receptive, you can then engage in the conversation.

‘The conversation itself should be about what the individual wants – what would the advantages be if they stopped smoking, what are the disadvantages if they continue to smoke – and it’s getting the individual then to address those broad questions.’

 

What should I avoid?

‘Stop giving specific advice. People don’t need to be told that smoking is bad for them, everybody knows that. What you’re trying to do is engage with the smoker so they can have a conversation where they build and develop motivation.

‘In other words, so that they have more reasons to give up smoking than they have to continue, and they’re motivated to do so.

‘Very often, I find it’s not health reasons [for people to give up], it’s family reasons, financial reasons or social reasons. Health reasons tend to come pretty far down the list.

‘Avoiding telling people to stop smoking seems totally counter-intuitive but if I tell you to lose weight, for example, you’re going to be defensive. That defensiveness protects your ego and if protecting your ego is the issue, you get to the point where you get into an argument and no one likes to lose an argument.

‘Engaging people very directly by telling them to stop smoking and that if they don’t they’re going to die is completely counter-productive.’

 

What if I offend someone?

‘If you’re offending people, you’re doing the wrong thing. If you do it right, asking indirect questions and guaging the individual’s response, you don’t get to the point where offense is achieved – you’ve backed off.’

 

Dr Terry Maguire is owner of Maguire Pharmacy, with two branches in Belfast, Northern Ireland


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