Table 2:

Suggestions and timelines for provider-delivered advice and counselling for patients with varying treatment goals

Treatment goalSuggested procedures and timelines
PrecessationPost-TQD follow-up visit(s)
Quit abruptly on TQD4Initial visit
  • Follow-up visits recommended at wk 1 and mo 1–3 after TQD

  • Assess smoking status

  • Congratulate those who have quit smoking

  • Query patient about adverse events

  • Encourage continued use of pharmacotherapy

  • Identify triggers and discuss coping strategies

  • If relapse has occurred, discuss reasons for relapse and treatment goal

  • Set TQD within next 4 wk

  • Provide written instructions for use of pharmacotherapy

  • Express confidence in patient’s ability to succeed

  • Focus on problem-solving (e.g., anticipate difficult situations and discuss coping strategies)

  • Remind patient to book follow-up 1–2 wk after TQD

  • Refer patient to adjunct behavioural support (i.e., individual or group counselling, telephone quit line, Internet-based support)

  • Provide self-help material

Preparation visit (optional)
  • Preparation visit recommended 1 wk before TQD

  • Ensure patient has begun pharmacotherapy

  • Reinforce advice and encouragement provided during the initial visit

Reduce to quit on TQD3841Initial visit
  • Follow-up visits recommended at wk 1 and mo 1–6 after TQD

  • Assess smoking status

  • Congratulate those who have quit smoking

  • Query patient about adverse events

  • Encourage continued use of pharmacotherapy

  • Identify triggers and discuss coping strategies

  • If relapse has occurred, discuss reasons for relapse and discuss treatment goal

  • Set TQD within next 4 wk

  • Patient to begin using medication 2–4 wk before TQD

  • Provide written instructions for use of pharmacotherapy

  • Express confidence in patient’s ability to succeed

  • Focus on problem-solving (e.g., anticipate difficult situations and discuss coping strategies)

  • Set reduction goals: decrease number of cigarettes per day by ≥25% during first week, ≥50% during second week and ≥75% by TQD

  • Suggest two common reduction techniques: systematically increase the amount of time between cigarettes; or rank order cigarettes from easiest to hardest throughout the day, then systematically start to eliminate on each day, from easiest to hardest

  • Remind patient to book follow-up visit 1–2 wk after TQD

  • Refer patient to adjunct behavioural support (i.e., individual or group counselling, telephone quit line, Internet-based support)

  • Provide self-help material

Preparation visit (optional)
  • Preparation visit recommended 1 wk before TQD

  • Ensure patient has begun using pharmacotherapy

  • Congratulate those who have reduced or quit smoking

  • Reinforce advice and encouragement provided during the initial visit

  • If patient has not reduced smoking, consider adjusting treatment

Reduce smoking4247
  • Explain how pharmacotherapy can be used to help reduce amount smoked

  • Encourage patient to set reduction goal (e.g., by 50%) or to reduce as much as possible

  • Suggest 2 common reduction techniques: systematically increase the amount of time between cigarettes; or rank order cigarettes from easiest to hardest throughout the day, then systematically start to eliminate on each day, from easiest to hardest

  • Refer patient to adjunct behavioural support (i.e., individual or group counselling, telephone quit line, Internet-based support)

  • Provide self-help material

  • Schedule follow-up within first month after smoking reduction

  • Query patient about adverse events

  • Query patient about success with reduction

  • Encourage patient to set new reduction goal

  • Ask if patient is interested in quitting; if patient wants to quit, set TQD and begin or schedule a preparation visit

  • Remind patient to book a follow-up visit if they decide they want to quit

No intention of reducing or quitting4
  • Conduct motivational intervention with the patient using “the 5Rs.” Ask the patient to identify: 1) why smoking is personally relevant; 2) the potential risks of continued tobacco use; 3) the potential rewards (benefits) of quitting; and 4) the potential roadblocks to quitting. 5) Repeat motivational interventions every 6–12 months.

  • Remind patient to book a follow-up visit if they become interested in quitting

  • Refer patient to adjunct behavioural support (i.e., individual or group counselling, telephone quit line, Internet-based support)

  • Provide self-help material

  • Ask if patient is interested in quitting; if patient wants to quit, set TQD and begin or schedule a preparation visit

  • Conduct motivational intervention

  • Remind patient to book a follow-up visit if they decide they want to quit

  • Note: TQD = target quit date.