General principles that will help you support a smoker
A motivational, non-judgemental style during consultations is more likely to engage patients than a judgemental, directional style. Playing the role of an interested partner who asks and explores a smoker's determination to quit is likely to be helpful. Motivational interviewing uses empathy rather than confrontation and acknowledges that the patient, not the doctor, is responsible for changing behaviour.
There are four key principles
- regard the person's behaviour as their personal choice
- let the patient decide how much of a problem they have
- avoid argumentation and confrontation
- encourage the patient to discuss the advantages and disadvantages of making a quit attempt. (See Motivational tension)
ASK about smoking status to open up a discussion about quitting smoking
ASSESS how motivated a smoker is to the idea of quitting and their degree of nicotine dependence
ADVISE on coping strategies to support the quit attempt
ASSIST the quit attempt
ARRANGE follow-up to provide continued support
|Q Here are some questions that can help assess motivation:|
- What is the positive side of smoking?
- What are the downsides to smoking?
- What do you fear most when quitting?
- On a scale of 1-10, how interested are you in trying to quit?
- What would need to happen to make this a score of 9 or 10?
- If a high score ask: what makes your motivation a 9 instead of a 2?
- How important is quitting to you right now?
- What reasons do you have for quitting smoking?
Here are some questions that can help assess confidence in ability to quit
- On a scale of 1-10, how confident do you feel in your ability to quit?
- If the smoker rates their confidence low (eg 2 or 3) ask what would need to happen to make this score an 8 or 9?
It is also useful to assess the barriers to quitting
- What would be the hardest thing about quitting?
- What are the barriers to quitting?
- What situations are you most likely to smoke?
- Ask about any previous quit attempts: What happened/caused you to restart smoking?
These questions help to determine nicotine dependence which, in turn, helps to determine appropriate therapeutic support:
- How many minutes after waking do you have your first cigarette?
- How many cigarettes do you smoke a day?
- Did you experience any craving or withdrawal symptoms at any previous quit attempts?
- What is the longest time you managed to quit?
(Smoking within 60 minutes of waking or smoking more than 15 cigarettes are strong markers for nicotine dependence)
How to use the Cycle of Change to help smokers quit