Help your patients quit smoking – for good!

Most smokers want to quit but are unable to do so successfully using willpower alone. In fact, it has been reported that two-third of smokers try abrupt cessation of smoking (i.e. ‘cold turkey’), but only 6% of them are successful. ¹ Current research supports this:

• 3 in 4 smokers who try to quit cold turkey relapse within one week ²
• After 6 months, 97% of smokers will have failed in their attempts to stop smoking unaided ²
• Most relapse occurs in first 8 days due to unresolved withdrawal symptoms ³

Quit attempts

According to a recent report entitled Tobacco Use in Canada: Patterns and Trends, one-half (49.6%) of smokers and recent quitters had made at least 1 quit attempt in the past year, and more than one-third had made multiple attempts (Figure 1). ⁴

The stages of change

Smokers generally go through a series of stages during their path to quitting (Table 1).⁵

Stage	Signs? Symptoms? Actions?
Pre-contemplation: Not thinking about quitting	May be discouraged by previous quit attempts or think it’s impossible to quit Process less information about smoking and have fewer negative reactions to smoking Not likely to be receptive to health benefits of quitting BUT – at some point, the vast majority think about quitting
Contemplation: Thinking about quitting, but not yet ready	Thinking about quitting in the next 6 months or less Think and feel more about themselves in relation to their smoking Most likely to respond to motivational interviewing
Preparation: Getting ready to quit	Made the decision to quit: the ‘pros’ of quitting outweigh the ‘cons’ Taking steps towards quitting e.g., reducing the number of cigarettes  Some set a ‘quit date’ Likely to be receptive to a well-defined smoking cessation plan/treatment
Action: Quitting	Actively trying to stop smoking Turning to family, friends and others to stay motivated Solidifying an action plan to deal with potential ‘slip-ups’ Need the most support to stay on track
Maintenance: Remaining a non-smoker	Have completed the recommended length of treatment (~10-12 weeks) Have learned how to manage triggers May slip, but try to learn how to not do so again Need continued reinforcement to help prevent a relapse

Consistent intervention and motivational interviewing is key

Most smokers will go through multiple quit attempts and interventions. The truth is that quit smoking programs often have fairly low success rates – but that doesn’t mean they are not worthwhile or should be discouraged. After all, 64% of Canadian smokers have already quit. ^4,6 It has been well-established that physicians can have a significant effect on the smoking behaviour of their patients.^7,8

Tips to help patients who are trying to quit:⁹

• Manage expectations: quitting often takes several attempts
• Be persistent: try not to be discouraged by a relapse; use it as a learning experience for both of you
• Make repeated contact: every visit is an opportunity to counsel your patients
• Help the smoker take the next step
• Bolster self-efficacy and motivation
• Match strategy to patient stage of change (e.g., motivating vs. creating a plan)

Motivational strategies

Motivational approaches focus on providing:

• Appropriate empathy
• Non-judgmental advice
• Personalized feedback (reflected back to the patient)
• Positive reinforcement

Motivational strategies can also support self-efficacy, promote autonomy and may be applied when patients are unready, unwilling or unable to quit smoking.

Very Brief Counselling

Very Brief Counselling is a short (<3 minutes) intervention that can be used for all patients, regardless of their motivation level to quit.¹⁰ From general practitioners to emergency department personnel, Very Brief Counselling is easy to integrate into every patient interaction, regardless of the health reason for the visit. Healthcare professionals hold a unique influence over patients’ decision-making. For further information about Very Brief Counselling, click here.

When smoking cessation advice is given by a healthcare professional, patients are more likely to listen – and quit.¹¹ Advice combined with medication has been shown to be even more effective.

According to the Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment (Can-ADAPTT) Canadian Smoking Cessation Guideline, combining counselling and smoking cessation medication is more effective than either alone. Therefore, where feasible, both should be provided to patients who are trying to stop smoking.¹²

Let your patients know about medication that can help them quit. Quit aids such as nicotine replacement therapy (NRT) can double a patient’s chances of success.^13,14 Click here to learn more about NRT and other medications and how they can help your patient quit successfully.

Studies on the role of the healthcare practitioner in smoking cessation indicate that even brief patient counselling can lead to quit rates ranging from 3 to 13%. More intensive intervention and follow-up sessions can lead to a 13 to 40% quit rate.¹⁵

Conclusions

Advice from a healthcare professional is a major trigger for a patient’s quit attempt. Indeed, an offer of support can lead to a quit attempt. Moreover, offering support is more important and more effective than simply advising patients to quit smoking. ³

References

1. Rigotti NA. Strategies to help a smoker who is struggling to quit. JAMA. 2012;308(15):1573-1580.
2. Hughes JR, Gulliver SB, Fenwick JW, et al. Smoking cessation among self-quitters. Health Psychol. 1992;11(5):331-334.
3. Aveyard P, Raw M. Improving smoking cessation approaches at the individual level. Tobacco Control. 2012;21:252-257.
4. Reid JL, Hammond D, Rynard VL, et al. Tobacco Use in Canada: Patterns and Trends. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo;2014.
5. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390-395.
6. American Cancer Society. A Word About Success Rates for Quitting Smoking. Available at: http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-success-rates. Accessed September 21, 2016.
7. Russell MAH, Wilson C, Taylor C, et al. Effect of general practitioners’ advice against smoking. BMJ. 1979;2(6184):231-235.
8. Ockene JK, Zapka JG. Physician-Based smoking intervention: a rededication to a five-step strategy to smoking research. Addictive Behav 1997;22(6):835-848.
9. Maryland Quitting Use and Initiation of Tobacco (MDQuit) Resource Center. Module 3: The Stages of Change. Available at: http://mdquit.org/fax-to-assist/module-3 . Accessed September 21, 2016.
10. National Centre for Smoking Cessation and Training. Very Brief Advice Training Module. Available at: http://www.ncsct.co.uk/publication_very-brief-advice.php. Accessed September 21, 2016.
11. Canadian Association of Occupational Therapists Position Statement. The Role of Health Professionals in Tobacco Cessation. Available at: http://www.caot.ca/default.asp?pageid=245 . Accessed September 21, 2016.
12. Algorithm for Tailoring Pharmacotherapy in Primary Care Setting. Available at: https://www.nicotinedependenceclinic.com/English/CANADAPTT/Pages/Home.aspx. Accessed September 21, 2016.
13. Cummings KM and Hyland A. Impact of nicotine replacement therapy on smoking behaviour. Annu Rev Public Health. 2005;26:583-599.
14. Fiore MC, Jaén CR, Baker TB, et al. Clinical practice guideline: treating tobacco use and dependence: 2008 update. Am J Prev Med. 2008;35(2):158-176.
15. Alberta Health Services. Tobacco Free Futures Guidelines, 2012. Available at: www.tobaccofreefutures.ca (link is external). Accessed September 21, 2016.