Consent precedes action, and this is no different for smoking cessation. Asking the right questions as a healthcare professional can prepare the patient mentally for the challenge ahead. And for this, we have the 5As framework.
The 5 As the framework of Smoking Cessation
| ASK | Identify smokers and document smoking status at every visit, which serves as a reminder to address cessation |
| ADVICE | Unambiguous support for smoking cessation should be clear, strong, and personalized. |
| ASSESS | Willingness to quit and barriers to quitting should be discussed, with smoking history and current level of nicotine use. Also, obtain their timeline for quitting and if any previous attempts were done. |
| ASSIST | Help anticipate difficulties e.g. withdrawals, mood changes/depression, and weight gain and prepare a support system (e.g. involving their family, cessation clinics, quit-line contacts). |
| ARRANGE | Set clear goals, with exact dates, as abstinence by the quit date is highly predictive of long-term success. |
But pertaining to this framework, what I would like to personally highlight is that oftentimes, after our patient has mentioned that they would like to quit and have begun on their journey, we tend to stop asking this set of questions. Something like a checklist that we mark done, and move on from. Even for patients who have successfully quit smoking, it would be nice to occasionally ask again, encourage and praise their efforts routinely thereafter. This is also taking into consideration that a quarter of patients who successfully quit, do have the tendency to relapse (read Part One of this four-part series covering the Evidence for Smoking Cessation).
However, what I believe most of us are less familiar with are the 5 Rs to motivate patients to quit smoking. In a nutshell, we must remember that smoking cessation is a 2-way conversation that will only be as effectively personalised if we listen more to our patients instead of us talking through our lists, or presenting our points of view. Ask open-ended questions.
The 5 R’s for Motivating Patients to Quit Smoking
| RELEVANCE | Encourage the patient to identify reasons to stop smoking that are personally relevant.
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| RISKS | Educate the patient on the harmful effects of continued smoking to both the patient and to others, incorporating aspects of personal and family history where possible.
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| REWARDS | Ask the patient to identify the benefits of smoking cessation e.g. improved health, financial savings, decreased cigarette odour, less anxiety on long-haul flights, positive influence on children etc. |
| ROADBLOCKS | Explore the anticipated barriers that the patient may encounter, and come up with possible solutions together:
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| REPEAT | Repetition is key. Include aspects of the five Rs in each clinical contact with unmotivated smokers. |
To round it off, I’d like to share a quote that you can keep at the back of your head to inspire your patients or keep them going.
“The best time to quit smoking was the day you started; the second best time to quit is today.”
References:
Larzelere, MM et al. (2012) Promoting Smoking Cessation. American Academy of Family Physicians.
