Table 2—

Recommendations to enhance motivation to quit tobacco: the “5 Rs”

RelevanceEncourage the patient to indicate why cessation is personally relevant, being as specific as possible. Motivational information has the greatest impact if it is relevant to a patient's disease status or risk, family or social situation (e.g. having children in the home), health concerns, age, sex and other important patient characteristics (e.g. prior cessation experience and personal barriers to cessation).
RisksThe clinician should ask the patient to identify the potential negative consequences of tobacco use. The clinician may suggest and highlight those that seem most relevant to the patient. The clinician should emphasise that smoking low-tar and/or low-nicotine cigarettes or use of other forms of tobacco (e.g. smokeless tobacco, cigars and pipes) will not eliminate these risks.Examples of risks are: Acute risks: Shortness of breath, exacerbation of asthma, harm to pregnancy, impotence, infertility and increased serum carbon monoxide. Long-term risks: Heart attacks and strokes, lung and other cancers (larynx, oral cavity, pharynx, oesophagus, pancreas, bladder and cervix), chronic obstructive pulmonary diseases (chronic bronchitis and emphysema), long-term disability and need for extended care. Environmental risks: Increased risk of lung cancer and heart disease in spouses; higher rates of smoking by children of smokers; increased risk for low birth weight, and sudden infant death syndrome and respiratory infections in children of smokers.
RewardsThe clinician should ask the patient to identify potential benefits of stopping tobacco use. The clinician may suggest and highlight those that seem most relevant to the patient.Examples of rewards are: Improved health: food will taste better. Improved sense of smell. Save money. Feel better about yourself. Home, car, clothing, breath will smell better. Can stop worrying about smoking cessation. Set a good example for children.
RoadblocksThe clinician should ask the patient to identify barriers or impediments to cessation and note elements of treatment (problem solving, pharmacotherapy) that could address barriers.Typical barriers might include: Withdrawal symptoms. Fear of failure. Weight gain. Lack of support. Depression. Enjoyment.
RepetitionThe motivational intervention should be repeated every time an unmotivated patient visits the clinic setting. Tobacco users who have failed in previous attempts should be told that most people make repeated cessation attempts before they are successful.