STAGE OF CHANGEQUESTIONS AND STRATEGIES

QUESTIONS TO ASK
Do you plan to quit smoking in the
next 6 months?
No (Precontemplation)

STAGES OF CHANGE

ASSISTANCE STRATEGIES

Provide personalized information about health

risks from smoking and benefits of cessation
(motivators such as health, children, selfcontrol, family/friends support, savings and
appearance).

Ask if there are demands to quit smoking at

home/work.

Offer assistance and follow-up appointment.

CONTEMPLATION

Seriously considering quitting

smoking in next 6 months

Acknowledge any ambivalence about quitting

and ask about motivators for quitting.
Help patients problem-solve to decrease the
barriers to quitting (such as weight gain, withdrawal symptoms, social/behavioural habits,
history of failure quitting).
Help identify resources/support.

PRECONTEMPLATION
No intention of quitting smoking within next 6 months

Yes (Contemplation)

If yes, Do you plan to quit in the

next month?
No (Contemplation)
Yes (Preparation)

If yes, Have you tried quitting in the

past year or made some changes, like
smoking less or delaying your first
smoke?
No (Contemplation)
Yes (Preparation)

PREPARATION

Ask if quit date has been set; if no, encourage

patient to set one. Consider a written agreement to be co-signed by yourself and patient.

Help patient increase awareness of smoking

habits with diary.

Establish patients degree of nicotine dependence by asking: How many cigarettes do you
smoke a day? and , When do you smoke your
first cigarette? (time from waking).

Determine whether NRT (patch or gum) is

appropriate. If appropriate, counsel on proper
use, dosage, regimen, side effects and avoiding
simultaneous use of tobacco products.

Determine what happened in past quit

attempts and previous use of NRT. Help patient
learn from past experience.

Determine why patient smokes (e.g., use WHY

test) to plan for triggers, develop coping strategies and obtain support. Ask what will serve as
a substitute for smoking.

Help identify rewards for each smoke-free day.

ACTION

Congratulate on success; offer support.

Successfully quit from 1 day to

6 months

Identify triggers and strategies/alternatives to

prevent slips or relapse.

Ask if patient is rewarding him/herself regularly.

MAINTENANCE

Free of tobacco use for more

than 6 months

Identify potential or unexpected triggers and

strategies to deal with them.

Support progress and monitor health.

Intending to quit in next

month; has tried to quit in past
year or made small behavioural
changes

Have you successfully quit smoking

in the last 1-day to 6-month period?
No (Preparation)
Yes (Action)

Have you remained free from smoking for six months or more (up to 5
years)?
No (Relapse)
Yes (Maintenance)

Do you experience total absence of

temptations, and are you 100%
confident in situations that were
previously high-risk?
No (Maintenance)
Yes (Termination)

TERMINATION
Patient experiences no temptations, and is 100% confident in
all previous situations that
were high-risk for smoking

HELPING YOUR PATIENTS QUIT SMOKING:

KEY ASSESSMENT AND MANAGEMENT STRATEGIES
As a pharmacist, you are in an excellent position to promote smoking cessation and help patients who
want to quit. Use the 4 As approachAsk, Advise, Assist, Arrange follow-up. Tailor your approach to best
meet individual patient needs.

ASK:

Ask all patients about tobacco use. Document smoking status in patient profile.

Do you smoke? or Has your smoking status changed since you were last in?
current smoker

former smoker

never smoked

If current smoker, Would you be willing to talk for a few minutes about your smoking?
yes

no

If yes, How do you feel about stopping smoking?

If former smoker, How long since you quit?

< 6 months

6 + months

ADVISE: Encourage all smokers to quit in a clear, personalized manner. Show empathy, dont be
judgemental.
Say As your pharmacist, I recommend you stop smoking. I need to tell you that quitting smoking is the
most important thing you can do for your health. Identify higher-risk patients and personalize quit
message based on illness (e.g., patients with asthma, COPD, diabetes, post-MI or stroke, hypertension, heart disease, osteoporosis), or pregnant women.

ASSIST: Determine the patients readiness to quit and offer your help. Express confidence in the
patients ability to succeed.
A Pegasus Healthcare International Publication, 1998.

Use the questions (on reverse) to determine the patients readiness to quit smoking (i.e., stage of
change). Help patients move through each stage (as detailed in the Smoking Cessation Guide for
Pharmacists). Avoid rushing them to action or forcing them to skip stages.

ARRANGE FOLLOW-UP: Following up with the patient increases the likelihood of success. Celebrate
progress and be positive.
Reassess patients smoking status or readiness to quit at each contact. For patients ready to quit,
contact them on quit date. Follow-up in person or by phone within one week of quit date, again
within 1 month of the stop date, and as indicated thereafter. Ask:

How are you dealing with cravings and stressful situations? Ensure patient has effective coping
strategies, reinforce their successes and encourage patient to reward him/herself each day.

Have you had any slips or have you started smoking again? If yes, discuss what happened and
strategies to deal with problem situations. If necessary, renew patient commitment to quit.

Ask about use of NRT products and discuss tapering schedule.

This publication has been produced in partnership with:

Published with the assistance of an educational grant from:

HABITROL STOP SMOKING SYSTEM INC.

Novartis Consumer Health Canada Inc.

L98-215E