Talking to Patients about Smoking Cessation

Asking patients about their smoking habits and motivating them to quit involves empathetic, nonconfrontational, and nonjudgmental communication.2,6 

Motivational interventions “explore a patient’s ambivalence to smoking cessation in an empathetic, questioning manner, which respects the patient’s autonomy and builds self-efficacy.”2 The AAFP recommends the “5 R’s” (Relevance, Risks, Rewards, Roadblocks, and Repeat) as components of a discussion to “enhance patients’ motivation to stop smoking.”2 

Planning and Timing 

The decision to quit smoking does not typically take place from one moment to the next but a process that tends to take place in stages. “One of the reasons so many quit attempts end in failure is that patients do not adequately plan ahead,” Robin Corelli, PharmD, Professor from the University of California, San Francisco, School of Pharmacy, told MPR

Every visit can be an opportunity to ask patients about their intentions to quit smoking and to discuss plans to make this happen. “The patient should set a quit date, ideally within the next several weeks, because you want to capitalize on the fact that they have made the decision and to act while that decision is fresh,” she advised.

Some patients pick a special day (eg, a birthday) to quit. But “I encourage patients to see the quit date itself as a ‘special day’ and I reach out on that date to congratulate them,” she recounted.

For other patients, quitting on a birthday might be difficult and they prefer a more routine date. Quitting when there is intense work pressure or during the holidays, might likewise be difficult.

“The decision of when to quit is a highly personal one,” she said. She encourages patients to “enlist support from friends, family, and coworkers, informing them of the quit date so that when times are challenging, the patient can tap into these individuals for assistance.”

She recommends that patients document smoking habits in a log for 3 to 5 days prior to their quit date, recording what time they smoked, what they were doing, and why they felt they needed or wanted a cigarette.

“Patients might discover that they were bored, or around another smoker, or they needed to get away from their desk at work so they took a ‘smoking break.’ This process enables introspection about smoking patterns, routines, and triggers which can inform the development of potential coping strategies prior to the quit date.” 

Dr Corelli also advises patients to get coaching when they are trying to quit. “The advantage of living in the US is that there is ready access to smoking cessation counselors at no cost through the national telephone quitline (1-800-QUIT-NOW [1800-784-8669]). This service, which is staffed by highly-trained specialists, helps callers develop personalized quit plans to manage challenges tied to particular tobacco use habits and routines.”