Utilize the 5 A’s model to assist your patient in taking the first steps toward cessation. For further guidance on how to promote cessation maintenance, see Individuals Who Have Recently Quit (below).
- Ask (about tobacco use)
- Gather information regarding tobacco use for every patient for every visit.
- Advise to Quit
- Assess willingness to make a quit attempt
- Is the client willing to make a quit attempt currently?
- Assist in the quit attempt
- Offer medication and either provide or refer for further counseling.
- Arrange follow-up
- Schedule a follow-up appointment within a week of quit date.
Resistance to quitting is a part of every ex-smoker’s past. As a supporter, it is important to help the individual understand that quitting is possible. To help empower your patients, consider the 5 R’s (below) to help guide your efforts.
Relevance – Discuss the importance of quitting.
Risks – Ask your client to identify risks and highlight those that are particularly relevant to the patient.
Rewards – Ask client to identify rewards, highlight the most relevant components.
Roadblocks – Ask client to identify potential barriers to quitting, mention any that he/she might miss, offer solutions (counseling, NRT, medication, etc.).
Repetition – Repeat motivational intervention each time unwilling client visits clinic. Reassure that any potential relapses are common for individuals seeking cessation.
As you utilize the 5 R’s strategy, consider integrating the following motivational interviewing techniques:
- Express Empathy
- Develop Discrepancy
- Roll with Resistance
- Support Self-Efficacy
For expanded information on Motivational Interviewing, refer to page 75 of A clinical practice guideline for treating tobacco use and dependence from