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The decisional balance can be used to better
understand their motivation (Table 1). Exploring both the likes and dislikes about smoking and
quiting gives the doctor a snapshot of the patient's likelihood of
changing. • Their confidence to quit on a scale of 1-10 (follow 'motivation scale' process)24 • Their dependence on nicotine. This can be achieved by asking two questions from the Fagerstrom Nicotine Dependence Questionnaire.25 'How many cigarettes do you smoke a day? How long after you wake do you have your first cigarette?' Those smoking more than 15 cigarettes a day and having their first cigarette within half an hour of waking are likely to be dependent on nicotine (approximately two-thirds of all smokers). This group are candidates for pharmacotherapy. • Previous quit attempts. 'What is the longest time you managed to quit? What helped you at this time? What tipped you back?' • High risk situations, e.g. 'Which cigarette would be the hardest to give up? What situations are you most likely to smoke?' Advise • Provide brief, clear, nonjudgmental advice to quit. Smokers are sensitive about their habit and react to being cajoled or 'told' to quit. Provide the information they need without the 'moral imperative' that they must do it. Remember the adolescent myth: adolescents usually do 'y' when asked to do 'x'. This myth continues past the age of 20 years. Think about the last time your partner really insisted that you do something. What did you do? While you probably complied, what you thought at the time was probably quite different! |
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