Smoking Cessation with Adult Patients: THE 5-R MODEL for tobacco users unwilling to quit
The 5 R's: Relevance, Risks, Rewards, Roadblocks, and Repetition
are designed to motivate smokers who are unwilling to quit at this time. Smokers may be unwilling to quit due to misinformation, concern about the effects of quitting or demoralization because of previous unsuccessful quit attempts. Therefore, after asking about tobacco use, advising the smoker to quit, and assessing the willingness of the smoker to quit, it is important to provide the "5 R's" motivational intervention.
Smoking Cessation with Adult Patients THE 5-R MODEL For Tobacco Users Unwilling to Quit The "5 R's," Relevance, Risks, Rewards, Roadblocks, and Repetition, are designed to motivate smokers who are unwilling to quit at this time. Smokers may be unwilling to quit due to misinformation, concern about the effects of quitting or demoralization because of previous unsuccessful quit attempts. Therefore, after asking about tobacco use, advising the smoker to quit, and assessing the willingness of the smoker to quit, it is important to provide the "5 R's" motivational intervention.
Relevance
Encourage the patient to indicate why quitting 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 (i.e., having children in the home), health concerns, age, gender and other important patient characteristics (i.e. prior quitting experience, personal barriers to cessation).
Risks
The clinician should ask the patient to identify potential negative consequences of tobacco use. The clinician may suggest and highlight those that seem most relevant to the patient. The clinician should emphasize that smoking low-tar/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, esophagus, pancreas, bladder, 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 in children of tobacco users, increased risk for low birth weight, Sudden Infant Death Syndrome, asthma, middle ear disease and respiratory infections in children of smokers.
Rewards
The 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:
- Improved health
- Food will taste better
- Improved sense of smell
- Save money
- Better self-image
- Home, car, clothing, breath will smell better
- Can stop worrying about quitting
- Set a good example for children
- Have healthier babies and children
- Eliminate worry about exposing others to smoke
- Feel better physically
- Perform better in physical activities
- Reduced wrinkling/aging of skin.
Roadblocks
The clinician should ask the patient to identify barriers or impediments to quitting 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 of tobacco.
Repetition
The motivational intervention should be repeated every time an unmotivated patient visits the clinic setting. Tobacco users who have failed in previous quit attempts should be told that most people make repeated quit attempts before they are successful.