70. For the Patient Unwilling To Quit

Treating Tobacco Use and Dependence: 2008 Update

Text version of slide presentation.

For the Patient Unwilling To Quit

Motivational Interviewing

Express empathyUse open ended questions to explore :
  • The importance of addressing smoking or other tobacco use (e.g., "How important do you think it is for you to quit smoking?").
  • Concerns and benefits of quitting (e.g., "What might happen if you quit?").

Use reflective listening to seek shared understanding:

  • Reflect words or meaning (e.g., "So you think smoking helps you to maintain your weight.").
  • Summarize (e.g., "What I have heard so far is that smoking is something you enjoy. On the other hand, your boyfriend hates your smoking and you are worried you might develop a serious disease.").

Normalize feelings and concerns (e.g., "Many people worry about managing without cigarettes.").

Support the patient's autonomy and right to choose or reject change (e.g., "I hear you saying you are not ready to quit smoking right now. I'm here to help you when you are ready.").

Develop Discrepancy
  • Highlight the discrepancy between the patient's present behavior and expressed priorities, values and goals (e.g., "It sounds like you are very devoted to your family. How do you think your smoking is affecting your children?").
  • Reinforce and support "change talk" and "commitment" language: "So, you realize how smoking is affecting your breathing and making it hard to keep up with your kids." "It's great that you are going to quit when you get through this busy time at work."
  • Build and deepen commitment to change: "There are effective treatments that will ease the pain of quitting, including counseling and many medication options." "We would like to help you avoid a stroke like the one your father had."

Previous Slide        Contents         Next Slide 

Current as of June 2009
Internet Citation: 70. For the Patient Unwilling To Quit: Treating Tobacco Use and Dependence: 2008 Update. June 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/presentations/2008update-full/slide70.html