Assessing patients who smoke
Stages of change in smoking cessation
One way of categorizing patients who smoke is to determine where they are in the "stages of change." A simple way of doing this is to establish whether and when a patient would be willing to consider quitting:
- A patient who says "never" or "in more than six months" is in the pre-contemplation stage.
- A patient who says "in more than one month, and less than six months" is in the contemplation stage.
- A patient who says "in the next month" is in the preparation stage.
- A patient who says he or she is "cutting down" or "has set a quit date" is in the action stage.
- A patient who quit more than six months ago is in the maintenance stage.
For patients who smoke and who are in the pre-contemplation stage, ask how they feel about their smoking. Simply talking about smoking may be a way to initiate a discussion that may lead to a quit attempt. Patients who smoke are more likely to return for help to a health care professional they perceive to be empathic and non-judgmental.
For patients who smoke who are in the contemplation stage, the primary task is to increase their motivation:
- Ask patients why they want to quit. Support and encourage their choice.
- Ask patients how confident they are about quitting and what would make them more confident.
- Ask patients whether they know about the various treatments that are available. You can provide evidence-based highlights of smoking cessation options.
- Ask patients what smoking does for them and what they might be able to do instead.
- Ask patients whether they would like some help when they decide to quit.
An assessment may help you determine how you can help a patient who smokes. People who smoke may have far less in common with one another than you might think.
Variables worth assessing include:
- amount smoked
- degree of dependence (e.g., cigarettes per day, time to first cigarette)
- patterns of smoking
- reasons for smoking
- reasons for quitting
- experience with quitting: what worked and what didn't
- previous relapse triggers
- other addictions, medical problems, psychiatric problems, medications
- current interest in quitting
- current confidence in being able to quit.
Assessment forms that you can use in your practice include:
- Smoking Progress Notes
- Decisional Balance Sheet
- Fagerström Test for Nicotine Dependence
- Smoking Diary.
Rapid assessment with patients who want to quit
- Ask how much the patient smokes.
- Ask what the patient has tried in previous quit attempts.
- Ask what the patient would like to try now.
- Ask whether the patient would like suggestions from you.
The Primary Care Addiction Toolkit: