Smoking Cessation with Adult Patients Stages of Change

Behavior change is rarely a discrete, single event. Physicians sometimes see patients who, after experiencing a medical crisis and being advised to change the contributing behavior, readily comply. More often, physicians encounter patients who seem unable or unwilling to change. During the past decade, behavior change has come to be understood as a process of identifiable stages through which patients pass. Physicians can enhance those stages by taking specific action. Understanding this process provides physicians with additional tools to assist patients, who are often as discouraged as their physicians with their lack of change.

The Stages of Change model shows that, for most persons, a change in behavior occurs gradually, with the patient moving from being uninterested, unaware or unwilling to make a change (precontemplation), to considering a change (contemplation), to deciding and preparing to make a change. Genuine, determined action is then taken and, over time, attempts to maintain the new behavior occur. Relapses are almost inevitable and become part of the process of working toward life-long change.

Precontemplation Stage

Patients are not considering a change. Smokers are "in denial" and may not even see that the advice applies to them personally.

Contemplation Stage

Patients are ambivalent about changing. Giving up an enjoyed behavior causes them to feel a sense of loss despite the perceived gain. During this stage, patients assess barriers (i.e. time, expense, hassle, fear, "I know I need to, Doc, but ...") as well as the benefits of change.

Preparation Stage

Patients prepare to make a specific change. They may experiment with small changes as their determination to change increases. For example, switching to a different brand of cigarettes may signal that they have decided a change is needed.

Action Stage

This is the stage that most physicians are eager to see their patients reach. Many failed New Year's resolutions provide evidence that if the prior stages have been glossed over, action itself is often not enough. Any action taken by patients should be praised because it demonstrates the desire for lifestyle change.

Maintenance and Relapse Prevention
Maintenance and relapse prevention involve incorporating the new behavior "over the long haul." Discouragement over occasional "slips" may halt the change process and result in the patient giving up.

Relapse/Recycle