STAGE: Not Ready to Quit

STAGE: Not Ready to Quit

You are a community pharmacist. You notice a woman, who looks to be in her twenties, standing in front of the nicotine replacement

products case, looking confused. You are able to stop your

prescription checking and approach the woman to see if she needs some help.

KEY POINTS

THIS PATIENT

ƒ is approached by the pharmacist, who sees her looking at the nicotine replacement therapy products

ƒ wants to quit, because her boyfriend dislikes smoking, but isn’t quite ready

ƒ is not ready to quit in the next 30 days

THE PHARMACIST

ƒ stages the patient’s readiness to quit

ƒ commends the patient on her interest in quitting and offers to assist her with quitting

ƒ encourages the patient to call when she is ready to quit

Step 1: ASK

Pharmacist

Hello, I’m the pharmacist. I see you’re looking at the nicotine products. Do you, or does someone you know, smoke?

Patient Yes. I smoke.

Step 2: ADVISE

Pharmacist

And are you considering quitting?

Patient

Yes. I really want to quit. I just started dating someone, 2 months ago. He doesn’t know that I smoke.

He’s very anti-smoking. So I need to quit.

Pharmacist

That’s great. Wanting to quit is the first step toward becoming a nonsmoker. I strongly encourage all of my patients who smoke to quit.

Step 3: ASSESS

Pharmacist

Are you thinking about quitting sometime soon—maybe in the next month or so?

Patient

Yeah. But I’m not quite ready to do it immediately. I mean, I like smoking. It calms me when I’m stressed…and it keeps my weight down. I’m trying to get psyched up for it. I’ve never tried to quit before, so right now I’m just kind of looking for information. What’s the easiest way to quit?

Step 3: ASSESS (cont’d)

Pharmacist

Well, there really is no “easy” way to quit, but we can discuss the available options to see which one is best suited for you. What’s most important, however, is that you’re fully committed—and ready—when you start your quit attempt.

This patient is not ready to quit in the next 30 days.

Step 4: ASSIST

;

What kind of tobacco do you currently use? And how much?

Patient

I smoke Marlboro Lights. Usually about a pack a day now—I’ve cut back a bit because I don’t smoke around my boyfriend.

;

How many years have you been smoking?

Patient

About 8 years, since college.

;

So it sounds like one of your main reasons for quitting is because your boyfriend dislikes it. Do you have any other motivations for staying off of tobacco?

Step 4: ASSIST (cont’d)

Patient

My main reason is my new boyfriend. And my health, I guess. But I don’t feel like my health is bad because of my smoking.

;

Do you believe that you can quit?

Patient

If I give myself enough time, I know I can do it. I just don’t want my boyfriend to find out that I smoke.

It’s getting harder to hide it.

;

Do you think that if you told your boyfriend, he might be able to support you when you decide to quit? If not, do you have any family members or friends who might be able to help you quit? Someone who can serve as a buddy for you?

Patient

I thought about telling my boyfriend, but the timing’s not right. We haven’t been dating that long. No one in my family knows that I smoke, and I don’t want them to ever know. My best friend quit smoking about 6 months ago.

Pharmacist

OK, well it sounds like you have several people who would be able to help.

Step 4: ASSIST (cont’d)

;

Not applicable. The patient is not ready to quit in the next 30 days. However, because she was looking at the nicotine replacement case, the pharmacist could briefly explain that there are several different methods for quitting, including nicotine gum, patch, and lozenge. And the pharmacist could tell the patient that he or she would be happy to discuss these in further detail in the next several months. It may be appropriate to advise the patient to complete a Tobacco Use Log, so that she can learn more about her smoking behavior, which will help her during her future quit attempt.

Step 5: ARRANGE

Pharmacist

I know that you don’t have immediate plans to quit smoking, but I am encouraged that you feel you want to quit sometime in the near future, and it sounds like you’d have good support from your family and friends.

I also encourage you to think about other reasons that you have for quitting smoking, besides the fact that your boyfriend doesn’t like it. I want you to be successful in your quitting, and it’s important to have other reasons for quitting. Medications can help, but none of them will make you quit if you aren’t fully committed to quitting. That’s why I’m glad you took time out of your day to speak to me, instead of hurrying to buy a nicotine replacement product. When you’re ready, I’ll be more than happy to help you develop a smoking cessation treatment plan to help you quit.