An attending physician is observing a medical resident conduct preventive counseling for tobacco cessation. The resident encounters patients in various stages of readiness to quit smoking. Match each patient statement (representing a specific stage of the transtheoretical model of change) to the most appropriate next step in physician counseling.
- "I only smoke a few cigarettes a day, and it is definitely not the reason my asthma is flaring up."Ask for permission to provide personalized information regarding how tobacco smoke triggers airway inflammation.
- "I know smoking is making my breathing worse, but I am terrified of gaining weight if I stop."Help the patient weigh the pros and cons of quitting while validating their specific concerns about body changes.
- "I plan to stop smoking completely by the first of next month, and I told my family about it."Finalize a concrete action plan, identify potential immediate triggers, and discuss appropriate pharmacotherapy options.
- "It has been 14 days since my last cigarette, though the urges after meals are still very intense."Praise the recent behavioral changes and brainstorm alternative activities to substitute during high-risk situational triggers.
Answer
The statement denying the link to asthma matches with asking for permission to provide information. The statement expressing fear of weight gain matches with exploring pros and cons. The statement about stopping next month matches with finalizing a concrete plan. The statement about being smoke-free for 14 days matches with brainstorming alternative activities.
Effective health education and counseling require tailoring the physician's intervention to the patient's current readiness to change, as described by the Transtheoretical Model. Precontemplation requires raising awareness without pressure. Contemplation requires exploring ambivalence (pros and cons). Preparation requires establishing a firm plan and offering tangible resources. Action requires support for relapse prevention.
Step-by-Step Solution
Key Concept
Transtheoretical Model of Change in Patient Counseling