Table 3.

Enhancing motivation to quit tobacco use-the “Five R's” for the patient unwilling to quit at this time.

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 (e.g., having children in the home), health concerns (morning cough, better sense of taste and smell, better breath) age, sex, and other important patient characteristics (e.g., 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 the 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, increased serum carbon monoxide levels. Long-term risks: myocardial infarction 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 by 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 improved health: food will taste better; improved sense of smell; save money; feel better about yourself; home, car, clothing, and breath will smell better; can stop worrying about quitting; set a good example for children; have healthier babies and children; not 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 clinical setting. Tobacco users who have failed in previous quit attempts should be told that most people make repeated quit attempts before they are successful.

From reference 36.