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Facilitating smoking cessation

Key message for smoking cessation

Tell patients that quitting is a process, not an event.

Learning to quit is often like learning any new behaviour: It is frustrating, it requires repeated practice, and it tends to involve failures before successes. Tell patients that repeated failures are normal and that failure is part of the learning process.

Smoking cessation tools to use with patients

The "Why Do I Smoke?" quiz

The American Academy of Family Medicine's "Why Do I Smoke?" quiz helps both you and the patient gain insight into the factors that motivate the patient to continue to smoke.

Smoking diary

A smoking diary helps you and the patient develop awareness about smoking patterns. It also interrupts habitual smoking because patients tend to reduce their intake when they have to consider why they are smoking a given cigarette.

Stop smoking contract

Some patients benefit from the extrinsic motivation provided by a written agreement with you or a significant other.

Decisional balance sheet for smoking

A "decisional balance" approach can help a patient who is in the contemplation stage and, thus, ambivalent about quitting. A decisional balance sheet facilitates discussion about the patient's reasons for and against quitting.

Self-help resources

A 2006 systematic review of smoking interventions (Ranney et al., 2006) concluded that self-help strategies alone have not been shown to increase quitting rates. Self-help materials should be made available to patients who are trying to quit smoking, but individual assistance should be offered as well.

Reducing versus quitting smoking

The evidence demonstrates that setting a quit date increases the likelihood of success, but many patients who smoke succeed in quitting or reducing their smoking without a quit date. If patients want to quit but feel unable or unwilling to quit abruptly, then encourage them to try a reduce to quit plan. You may offer them nicotine gum to manage cravings while they gradually cut down daily smoking.

Reducing cigarette intake should be seen as a goal in itself. From a harm reduction perspective, it reduces exposure to smoke and nicotine, and reduction increases the likelihood of complete abstinence in the future.

Preparing patients to quit

Consider having patients commit to working on a smaller goal before they quit smoking altogether or instead of setting an absolute quit date: "Quit before you quit."

Examples of "quitting before you quit" include quitting smoking inside the home, car or office. This often seems more manageable than quitting outright. It also helps patients begin the pattern interruption that is important for behavioural change, and allows the home to be cleaned and freed of smoking odours and associations.

Weight gain and smoking cessation

People who quit smoking typically gain two to four kilograms over the first three months. Most who have remained abstinent for one year return to their pre-quitting weight, and many manage to lose weight. It is not recommended that patients attempt losing weight while trying to quit smoking. Tell patients who smoke that once they have quit they can turn their attention to losing a few kilograms.

Consider bupropion (Zyban) with patients for whom weight gain is a serious concern. Bupropion tends to reduce appetite and has been demonstrated to prevent weight gain in patients who are trying to quit smoking.

Smoking cessation is not just about quitting smoking: It usually involves making a new set of choices about healthy behaviour and lifestyles. People who have stopped smoking tend to eat better, exercise more and handle stress more appropriately.