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.
Facilitating Smoking Cessation
Key message for Smoking Cessation
Tell patients that quitting is a process, not an event.
Learning to quit is often like learning any new behaviour: It may be frustrating, it requires repeated practice, and it tends to involve failures before successes. Tell patients that repeated failures are normal and that failure is part of the learning process.
Smoking cessation tools to use with patients
The "Why Do I Smoke?" Quiz
The American Academy of Family Medicine's "Why Do I Smoke?" quiz helps both you and the patient gain insight into the factors that motivate the patient to continue to smoke.
A smoking diary helps you and the patient develop awareness about smoking patterns. It also interrupts habitual smoking because patients tend to reduce their intake when they have to consider why they are smoking a given cigarette.
Stop Smoking Contract
Some patients benefit from the extrinsic motivation provided by a written agreement with you or a significant other.
Decisional Balance Sheet for Smoking
A "decisional balance" approach can help a patient who is in the contemplation stage and, thus, ambivalent about quitting. A decisional balance sheet facilitates discussion about the patient's reasons for and against quitting.
A 2019 Cochrane systematic review of interventions of self-help materials found it is superior in helping smokers quit relative to no self-help materials. However, when counselling and cessation pharmacotherapy is given by health care providers, the benefit of self-help material is not seen. Therefore, self-help materials should be made available to patients who are trying to quit smoking, but individual couselling should be offered as well.
Reducing versus Quitting Smoking
The evidence demonstrates that setting a quit date increases the likelihood of success, but many patients who smoke succeed in quitting or reducing their smoking without a quit date. If patients want to quit but feel unable or unwilling to quit abruptly, then encourage them to try a reduce to quit plan. You may offer them nicotine gum to manage cravings while they gradually cut down daily smoking.
Reducing cigarette intake should be seen as a goal in itself. From a harm reduction perspective, it reduces exposure to smoke and nicotine, and reduction increases the likelihood of complete abstinence in the future.
Preparing Patients to Quit
Consider having patients commit to working on a smaller goal before they quit smoking altogether or instead of setting an absolute quit date: "Quit before you quit."
Examples of "quitting before you quit" include quitting smoking inside the home, car or office. This often seems more manageable than quitting outright. It also helps patients begin the pattern interruption that is important for behavioural change, and allows the home to be cleaned and freed of smoking odours and associations.
Weight Gain and Smoking Cessation
People who quit smoking typically gain eight to eleven pounds over the first six months following the quit.. Post-cessation weight gain can be mitigated by incorporating health eating and physical activity into one’s routine. It is important to advise patients that the health benefits of quitting still remains despite the weight gain. In the case the patient is obese or developed obesity post-quit, it is important to refer to publically funded obesity management clinics.
Smoking cessation is not just about quitting smoking: It usually involves making a new set of choices about healthy behaviour and lifestyles. People who have stopped smoking tend to eat better, exercise more and handle stress more appropriately.