Dean Health Plan Incorporates Bucket Approach to Invite Individuals to Address Tobacco Use

Kathy Chambers
Kathy Chambers

When Kathy Chambers started helping patients at Dean Health Plan by Medica to quit smoking, she quickly realized not every person is on the same journey with tobacco use. Some smoke or vape a few times a day, some two packs a day. Some have smoked or chewed a few years, others for decades.

“You can’t cookie cutter the support for someone who is exploring a quit,” said Chambers, a health transformation consultant at Dean Health Plan.

She quickly found that, if she asked them to quit using tobacco right away, it was too much for most people. She recognized that the greatest driver of human behavior is fear of loss, and in this case, they’re giving up a coping mechanism in using tobacco that many have used since adolescence. And, when they enter a program, they don’t necessarily know if they are ready to lose that crutch or feel required to quit right away. That creates anxiety.

“The individual is the expert in their use,” she said.

She’s working with an individual now who wouldn’t quit right away but was willing to talk about quitting and eventually began reducing their cigar use. The patient went from smoking more than 50 cigars per week, and lighting those more than 100 times, to half that amount.

Chambers has worked with this patient to change habits. The patient tried a practice quit attempt for 24 hours. In that time, the patient noticed better breathing and sleeping and found smoking to be less enjoyable when starting again.

Another patient went from smoking 12 cigarettes per day to two. The patient has life stress and isn’t ready to quit completely but has committed to revisiting this with Chambers in the fall.

Chambers said the Bucket Approach, developed by Dr. Bruce Christiansen, a retired UW-CTRI researcher, helped her to develop a program that could work for patients at various stages of their tobacco use journey.

Christiansen developed the original Bucket Approach for use with people with severe mental illness, who often needed more time, patience and understanding to be successful in addressing their tobacco use. However, when Chambers reached out to Christiansen through UW-CTRI, they agreed that the approach could be used for any person interested in addressing tobacco use because it’s based on evidence for the general population.

The bucket approach helps providers sort patients by inclination to quit into so-called "buckets" as a way to best empower them to quit smoking

“I love the Bucket Approach,” Chambers said. “It’s a unique program and I’m so glad I came across it. I found that every person’s quit journey looks different. When you give them agency and they realize they’re in control of the nicotine, things start to shift. I ask them, ‘What would it be like for you to be the one controlling the nicotine? You get to make the conscious choice.’”

Chambers works one-on-one whenever possible to develop a tailored timeline. They practice deep breathing and making mindful decisions.

In addition to this program, the Dean Health Plan Health Promotion team also offers the American Lung Association’s Freedom from Smoking program. The health transformation consultants refer to the Wisconsin Tobacco Quit Line for additional support for individuals who do not have insurance through the health plan.

Chambers recently worked with four patients who all were dealing with aging parents. They created a support group that addressed their situational stress and smoking.

She said she reviews tobacco use data with each member of the program to highlight their efforts and movement towards their reduction goals. The evidence helps to shift their perspective of not doing enough to realizing they have had a significant reduction in their tobacco use. Sometimes, they even decide to reduce their tobacco use more or even quit.

“I never thought I’d enjoy doing nicotine cessation programming,” Chambers said with a laugh, “but it’s truly fun to watch people succeed and take pride in who they are.”