Patient-Centered Counseling
What are the three steps of patient-centered counseling?
1. Assess (before telling)
2. Build Rapport
3. Tailor Counseling
List the 5 A's of the Approach Model
1. Assess
2. Advise
3. Agree
4. Assist
5. Arrange
What are the six stages of change in the transtheoretical model (in order)?
1. Precontemplation
2. Contemplation
3. Preparation/Determination
4. Action
5. Maintenance
6. Relapse
Ms. M., a 40 year-old who has had multiple attempts with quitting says, “I quit during all 3 pregnancies, but after the births of my children I gained too much weight and went back to smoking.” Your statement, “You’ve had some excellent success with staying off cigarettes” is an example of:
A. Empathy
B. Reflection
C. Agreement
D. Affirmation
E. Assistance
D. Affirmation
What is perceived ability to change?
Perceived ability to change
Which part of the 5 A's Approach Model is described below:
________: to help patients identify and overcome barriers to implementing change
Assist
Assist patients in developing action strategies
Help patients identify and overcome barriers to implementing change
"Roll with resistance"
In the preparation/determination stage, an individual has the intention to take action within what period of time?
Within the next month
During a clinical encounter in which you address smoking, a key question that will help you plan a strategy for your intervention is:
A. “Did you ever use medications to help you quit?”
B. “Does anyone else in your household smoke or use tobacco?”
C. “How interested are you in quitting smoking?”
D. “How long have you been smoking?”
C. “How interested are you in quitting smoking?”
Motivations to change are elicited from __________ and not imposed by __________.
Motivations to change are elicited from the patient and not imposed by the physician.
What model should you use when advising a patient regarding a needed behavioral change?
Ask, Tell, Ask Model
Ask the patient if they're okay with you providing some advice
Tell/Educate the patient on the necessary behavior change
Ask for their understanding
What stage of change is the following individual in:
The individual has changed their behavior, maintained the change for more than 6 months, and is working to sustain the change.
Maintenance Stage
Weight concerns, fear of getting addicted to medications, and other smokers in the house correspond to which of the 5 R's for motivating unmotivated smokers?
Roadblocks
Reflective listening, expressing empathy, and providing affirmation and support correspond to what part of patient-centered counseling?
Build Rapport
The last step for physicians utilizing the 5 A's Approach Model is to arrange a follow up with their patient. Specifically regarding smoking cessation, how soon should this follow up appointment occur?
Within 1-2 weeks
Your long term patient is talking about her use of marijuana, and says, "I've been through this before. I stopped for a whole year. I’ve been using marijuana again for 6 months. I know I can do it and I know I should stop, but I just don't want to talk about it!" Which stage of change is this patient currently in?
Contemplation Stage
A patient comes into his physician's office and admits to smoking 0.25 packs per day for the last 20 years. How many pack years?
5 pack years
0.25 packs/day * 20 years = 5 pack years
Mr. 21pack-a-day comes into his primary care physician's office for his routine checkup. When discussing social history the patient admits to "ripping cigs all day" because he hates his job. His grandfather lived to be 101 years old and smoked 25 packs/day, and he believes that he will be fine because he is smoking less than his grandfather. He states he has to cope with his stress somehow and that his lungs are fine because he doesn't have any trouble breathing. The physician responds to the patient saying "You can find a way to cope other than cigarettes and your lungs are being very negatively affected."
Which part of the "RULE" mnemonic did the physician fail to do?
The physician failed to resist the righting reflex.
"RULE" Mnemonic
Resist the righting reflex
Understand the patient's emotions
Listen to patients
Empower patients to make a change
What are the two components of the Visual Readiness Rule (0-10 scale) that encompass a patient's sense of importance in changing a behavior?
Conviction and Confidence
Conviction: assesses what the patient believes about the importance of taking an action
Confidence: assesses what a patient believes about their ability to change
You tell a new patient that she has high cholesterol. She expresses surprise when told that she could reduce her risk for heart disease by changing her diet and increasing physical activity, but doesn't believe that those changes would affect her. At this moment, what stage of change is the patient currently in?
Precontemplation Stage
Health improvement, money, healthy children, self-esteem, and improved smell and taste correspond to which of the 5 R's for motivating unmotivated smokers?
Rewards