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The 5 R's for Patients Unwilling to Quit Smoking

for Health Care Providers

The 5 R's for Patients Unwilling to Quit

Back to Smoking Cessation Chapter

Adapted from Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 UpdateLink will take you outside the VA website.. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service; May 2008.
  • Relevance: Explain to patients why cessation is personally relevant (eg, comorbidities, cost).
  • Risks: Ask patients to explain their perceived potential risks of smoking; discuss these risks with them (eg, sexual dysfunction, infertility, fetal harm, CV and pulmonary disease, malignancies, secondhand smoke). Explain that:
    • 20 minutes after quitting, heart rate and blood pressure drop
    • 12 hours after quitting, carbon monoxide levels drop to normal
    • 2 weeks to 3 months after quitting, circulation and lung function improve
    • 1 year after quitting, risk of coronary heart disease is cut in half
    • 5 years after quitting, stroke risk is the same as for nonsmokers
    • 10 years after quitting, lung cancer risk is cut in half
  • Rewards: Ask patients to explain what they might gain from cessation (eg, breath smells better, stained teeth get whiter, bad odor of clothes goes away, food tastes better, sense of smell returns to normal, everyday activities do not result in shortness of breath, skin tone gets better, health improves, worries about secondhand smoke lessen, respiratory symptoms improve, lung function improves).
  • Roadblocks: Ask patients to identify barriers to quitting (eg, fear of failure, weight gain, depression) and offer options to address those barriers.
  • Repetition: Discuss these issues with patients at each visit.

From Smoking Cessation
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009