6 INSTRUCTOR GUIDELINES

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1 STAGE: Not Ready to Quit You are a clinician in a family medicine practice, and one of your patients, Ms. Stinson, has an appointment today because she is experiencing some difficulty breathing and is coughing, which she believes is related to allergies. KEY POINTS THIS PATIENT wants to quit smoking to improve her breathing, and because her boyfriend dislikes smoking, but she isn t quite ready wants to quit in the next 6 months but not in the next 30 days (in the contemplation stage) THE CLINICIAN stages the patient s readiness to quit commends the patient on her interest in quitting and offers to assist her with quitting encourages the patient to call when she is ready to quit Rev Page 1 of 5

2 Step 1: ASK Your difficulty breathing, and the coughing, may be related to allergies but it also may be caused by other factors. Are you a tobacco user? Yes. I smoke cigarettes. Step 2: ADVISE And are you considering quitting? Yes, especially if it will improve my breathing. Plus, I just started dating someone, 2 months ago. He doesn t know that I smoke. He s very anti-smoking. So I need to quit. That s great. Wanting to quit is the first step toward becoming a nonsmoker. I strongly encourage all of my patients who smoke to quit. Step 3: ASSESS Are you thinking about quitting sometime soon maybe in the next month or so? Yeah, but not yet. I m trying to get psyched up for it. I ve never tried to quit before. What s the easiest way? I was looking at those nicotine patches the other day at the pharmacy. I hear that they re good. Rev Page 2 of 5

3 Step 3: ASSESS (cont d) Well, there is no easy way to quit, but we can talk about the options to see which is best suited for you. What s most important is that you re fully committed and ready when you start your quit attempt. This patient is ready to quit in the next 6 months, but not in the next 30 days (in the contemplation stage). Step 4: ASSIST Assess tobacco use history: current use What kind of tobacco do you currently use? And how much? I smoke Marlboro Lights. Usually about a pack a day now I ve cut back a bit because I don t smoke around my boyfriend. Assess tobacco use history: past use How many years have you been smoking? About 8 years, since college. Discuss key issues: reasons/motivation for wanting to quit What are your motivations for quitting? Rev Page 3 of 5

4 Step 4: ASSIST (cont d) My main reasons are to improve my breathing and because my new boyfriend doesn t like smoking. Discuss key issues: confidence in ability to quit Do you believe that you can quit smoking? If I give myself enough time, I know I can do it. I just don t want my boyfriend to find out that I smoke. It s getting harder to hide it. Discuss key issues: social support for quitting Do you think that if you told your boyfriend he might be able to support you when you decide to quit? If not, do you have any family members or friends who might be able to help you quit? Someone who can serve as a buddy for you? I thought about telling my boyfriend, but the timing s not right. We haven t been dating that long. No one in my family knows that I smoke, and I don t want them to ever know. My best friend quit smoking about 6 months ago. Facilitate quitting process: discuss methods for quitting Not applicable. The patient is not ready to quit. However, because the patient has considered nicotine patches, the physician could briefly explain the different methods for quitting and tell the patient that he or she would be happy to help her select a method, when she is ready. Rev Page 4 of 5

5 Step 5: ARRANGE I realize that you don t have immediate plans to quit smoking, but I am encouraged that you feel you want to quit sometime soon, and it sounds like you might have a good support friend to help you through it. I invite you to call me in a couple of months so we can discuss how to proceed with your quitting. We can discuss strategies to help you prepare to quit, when you are ready to set an actual quit date. Medications like the nicotine patch and gum can help, but none of them will make you quit if you aren t fully committed to quitting. That s why I m glad you took time to discuss it before you hurry off to buy nicotine patches. When you re ready, I ll be more than happy to help you develop a smoking cessation treatment plan to increase your chances of quitting successfully. Rev Page 5 of 5 Copyright The Regents of the University of California, University of Southern California, Western University of Health Sciences, and Yale University. All rights reserved.

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