Text adapted in 2021 from Smoking Cessation in The Primary Care Addiction Toolkit (online only). A complete list of Toolkit authors, editors and contributors is available here.
Assessing Patients who Smoke
Stages of Change in Smoking Cessation
One way of categorizing patients who smoke is to determine where they are in the "stages of change." A simple way of doing this is to establish whether and when a patient would be willing to consider quitting:
- A patient who says "never" or "in more than six months" is in the pre-contemplation stage.
- A patient who says "in more than one month, and less than six months" is in the contemplation stage.
- A patient who says "in the next month" is in the preparation stage.
- A patient who says he or she is "cutting down" or "has set a quit date" is in the action stage.
- A patient who quit more than six months ago is in the maintenance stage.
For patients who smoke and who are in the pre-contemplation stage, ask how they feel about their smoking. Simply talking about smoking may be a way to initiate a discussion that may lead to a quit attempt. Patients who smoke are more likely to return for help to a health care professional they perceive to be empathic and non-judgmental.
For patients who smoke who are in the contemplation stage, the primary task is to increase their motivation:
- Ask patients why they want to quit. Support and encourage their choice.
- Ask patients how confident they are about quitting and what would make them more confident.
- Ask patients whether they know about the various treatments that are available. You can provide evidence-based highlights of smoking cessation options.
- Ask patients what smoking does for them and what they might be able to do instead.
- Ask patients whether they would like some help when they decide to quit.
An assessment may help you determine how you can help a patient who smokes.
Variables worth assessing include:
- amount smoked
- degree of dependence (e.g., cigarettes per day, time to first cigarette)
- patterns of smoking
- reasons for smoking
- reasons for quitting
- experience with quitting: what worked and what didn't
- previous relapse triggers
- other addictions, medical problems, psychiatric problems, medications
- current interest in quitting
- current confidence in being able to quit.
Assessment forms that you can use in your practice
Decisional Balance Sheet
Detailing the pros and cons of continuing to smoke as opposed to cutting down or quitting.
Fagerström Test for Nicotine Dependence
Quiz to analyze when and why clients smoke.
Daily diary for tracking when people smoke, how much they smoke and other comments.
Rapid Assessment with Patients who Want to Quit
Heaviness of Smoking Index (HSI)
1. How many cigarettes do you typically smoke per day
A. 10 or fewer (0 points)
B. 11-20 (1 point)
C. 21-30 (2 points)
D. 31 or more (3 points)
2. On the days that you smoke, how soon after you wake up do you have your first cigarette?
A. Within 5 minutes (3 points)
B. 6- 30 minutes (2 points)
C. 31-60 minutes (1 point)
D. After 60 minutes (0 points)
- 0-2: low addiction
- 3-4: moderate addiction
- 5-6: high addiction
Ask how much the patient smokes.
- Ask what the patient has tried in previous quit attempts.
- Ask what the patient would like to try now.
- Ask whether the patient would like suggestions from you.