Motivating Your Patient to Quit
PHS-Clinical Practice Guideline
These strategies are brief interventions that can be provided by any clinician with the goal of changing clinical culture and practice patterns to ensure that every patient who uses tobacco is identified and offered treatment.
Five Major Steps to Intervention
Tobacco is the single greatest preventable cause of disease and premature death in America today.
Place your cursor over each of the 5 A's for more details.
Adapted from "Treating Tobacco Use and Dependence" PHS Clinical Practice Guideline
 The five major steps (the 5 As) to intervene with tobacco users that are willing to quit are to ask the patient if he or she uses tobacco, advise him or her to quit, assess willingness to make a quit attempt, assist him or her in making a quit attempt, and arrange for follow up contacts to prevent relapse. This should take at less than five minutes of direct clinician time. The patient willing to quit should also receive pharmacotherapy in addition to the counseling.
View Chart of Clinical Guidelines for Prescribing Pharmacotherapy for Smoking Cessation
Five Major Steps to Intervention for Patients Not Ready to Make a Quit Attempt
Clinicians should have their tobacco use status assessed routinely. If after the assessment a patient is not willing to make a quit attempt then clinicians should use the motivational intervention (5 R’s) designed to promote the motivation to quit.
Place your cursor over each of the 5 R's for more details.
 Relevance, risks, rewards, roadblocks and repetition are the 5R’s of the motivation intervention that provides the clinician an opportunity to educate, reassure, and motivate. Motivational interventions (5 R’s) are most likely to be successful when the clinician is empathic, promotes patient autonomy, avoids arguments, and supports the patient’s self-efficacy.
Relapse usually occurs soon after a person quits, but sometimes it can occur months or years later. It is important to encourage and congratulate any successes for every ex-tobacco smoker. When meeting a recent quitter, use open-ended questions and encourage active discussion. The topics for discussion should include any success the patient has in quitting, the benefits that the patient may derive from cessation, and the problems encountered or anticipated threats to maintaining abstinence.
Please contact Tri-County Cessation Center for technical assistance or for more information about the 5A's and the 5R's.
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