Transcript Using Standardized Patients to Teach Smoking Cessation Susan Stangl, MD, MSEd

Using Standardized Patients to
Teach Smoking Cessation
Susan Stangl, MD, MSEd
David Geffen School of Medicine
at UCLA
Today’s Agenda
• Standardized patient case development
• Working with standardized patients in
the small group
• Go through a smoking cessation module
Standardized Patient Case
Development
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Choose a broad theme or topic
Determine learning objectives
Select a case
Decide the format of the case
Develop the case outline and patient
profile
• Documents needed for a complete case
Working with Standardized
Patients
• Before the patient arrives
– Presenting situation
– Choose interviewers
• During the interview
– Time outs
– Switching interviewers
– Let the students do it
Help Reluctant Patients to Quit
• Relevance: ask for their OWN reasons
why they should quit
• Risks: emphasize risks for THAT patient
• Rewards: highlight benefits of quitting
for THEM
• Roadblocks: acknowledge barriers and
help overcome them
• Repetition: repeat at each visit
Pharmacotherapy
• For all smokers unless pregnant, <10
cigs/day, adolescents
• 1st line Rx
– Bupropion SR
– Nicotine inhaler or nasal spray
– Nicotine patch or gum (no Rx needed)
• 2nd line Rx
– Clonidine
– Nortryptiline
Stages of Behavior Change
• Pre-contemplation - Denial (Try to move
from “No” to “Maybe”)
• Contemplation - Ambivalence (Leave
decision to them; be available)
• Determination - Motivated to change
(Provide direction & support)
• Action - Engaged in change
• Maintenance - Maintaining change
• Relapse - Ambivalent or motivated
5 “A’s” of Smoking Cessation
• ASK: All patients at each visit
• ADVISE: All patients to quit
• ASSESS: Ready to quit now or in the
next 30 days
• ASSIST: Set a date; anticipate
problems; provide counseling and info
• ARRANGE follow-up within 2 weeks
Pros & Cons of Changing
Behavior
• Ask patient to think about the following:
– Benefits of smoking (or not losing weight,
not exercising, etc.)
– Drawbacks of smoking
– Benefits of quitting smoking
– Drawbacks of quitting smoking
• After this exercise, does patients still
want to try to make a change?