By Carolyn J. Swenson, M.S.P.H., M.S.N., R.N., Peer Assistance Services, Inc.
From the Winter 2019 Journal of the Colorado Dental Association
Imagine this scenario: your patient reports that he/she currently smokes or uses another form of tobacco. You know that it is important to encourage them to quit but you only have a few minutes and you know that these conversations can be uncomfortable. You may also wonder if your advice will really make a difference. There is good news! Brief conversations with patients using Motivational Interviewing (MI) can help promote readiness, confidence and commitment to change.
Here are some key points: Bring up the topic by asking permission to have the discussion. Reassure patients that you ask everyone about tobacco, alcohol and other drug use as part of providing good care. If they do not want to discuss the issue, it is important to respect their autonomy and not pressure them to listen to your advice. If they do not want to discuss substance use, they are probably unlikely to be ready to change at this time. You can always revisit the issue at future visits and may find that they are more receptive once they see that you are not going to lecture them or push them to change. Try to listen at least as much as you talk. This demonstrates a genuine desire to understand your patient’s experience. Find out what they already know and what they have already tried. This helps you identify what information and resources will be most helpful. Communicate your belief that change is possible because often patients who have been unsuccessful in the past believe that they cannot be helped.
Elicit-Provide-Elicit, also known as Asking-Listening-Informing, is one approach to a brief conversation. First, ask what the patient already knows and what they have already tried. Next, listen for clues about what information and assistance will be most helpful. Then, provide information and plan next steps with the patient.
Here is a sample conversation:
Dental professional: “Thank you for completing our intake form, Ted. We ask everyone about tobacco, alcohol and drug use so we can provide the best possible care. You indicated that you use tobacco. Would it be ok to talk about that for a few minutes?
Ted: “Yeah, I suppose…”
DP: “I’m curious to find out what you know about how smoking can affect your health.”
Ted: “Oh, I know it causes lung cancer and breathing problems. I’ve heard it all before.”
DP: “So, you know that smoking is linked to some major health problems. What do you know about how it can affect your oral health?”
Ted: “I’ve honestly never heard about that.”
DP: “Well, smoking can also lead to gum disease and loss of teeth, oral cancer, and it dulls your senses of smell and taste, so your food doesn’t taste as good. What do you think about this information?”
Ted: “It doesn’t sound good…”
DP: “What are your thoughts about quitting?”
Ted: “Oh, I’ve tried. I used one of those nicotine patches and quit for a few weeks. Then things got stressful at work and it was just too hard. I think I’m one of those people who just can’t quit.”
DP: “So, it sounds like you wanted to quit and were able to be successful for a while. Could I share information about what works best to help a person quit?”
Ted: “Sure, why not.”
DP: “First of all, it often takes multiple tries to quit for good. The more times you try, the greater your chances of success. Also, using more than one approach to quitting at the same time—like nicotine replacement plus coaching—also helps a person be successful.”
Ted: “So, maybe I’m not a failure after all?”
DP: “Right, you are definitely not a failure. It sounds like finding different ways to handle stress may be important to help you quit. What do you think?”
Ted: “Definitely. Cigarettes are a major outlet for my stress. They help me calm down when I am worried or frustrated.”
DP: “The QuitLine offers free coaching and nicotine replacement patches, and they would help you explore different ways to handle stress.”
Ted: “Hmmm…interesting. I think I’ve seen their ads on TV.”
DP: “So, given all this information, what next steps make sense for you?”
Ted: “Well, I suppose it can’t hurt to try again. I’d like to keep my teeth
DP: “That sounds like a great plan. We can provide information to help you connect with the QuitLine. Thank you for having this conversation with me today.”
Change is difficult, and change is possible. Using MI to convey health information and advice is can help patients change.
For further information and training on SBIRT, visit sbirtcolorado.org. For information on the Dental Peer Health Assistance Program, visit phap.squarespace.com.