Table 5

Components of a plan of action to stop smoking

• identify the smoker
• ask about current cigarette intake
• measure level of dependence
• patient records pattern of use in a day diary (a self-monitoring device)
• assess patient’s readiness to stop smoking
• encourage motivation to stop smoking by engaging the smoker in motivational interviewing to weigh up the pros and cons of quitting. If the patient is in the “not ready” stage, encourage the patient to consider the habit and offer help; if in the “unsure” stage, provide brief motivational interviewing; if in the “ready” to quit stage, encourage the smoker to set a quit day
• personalise the health effects of smoking if the patient has concerns about health
• perform a lung function test if the patient is interested
• set a goal of not smoking
• discuss the variety of alternatives and substitutes to smoking: behavioural and cognitive
• discuss the use of nicotine replacement therapies such as the gum or patch
• discuss concerns about quitting, e.g. coping with work pressure or weight gain and what to do about maintaining weight
• identify high risk smoking situations so that alternative strategies can be planned to prevent relapse
• offer written materials (booklets) which will reinforce the non-smoking message
• establish a reward system for not smoking, both short and long term rewards
• enlist the support of family and friends
• develop an emergency plan for lapses which should be regarded as learning experiences and not as failures
• recommend follow up visits to monitor progress and review achievements and problems.