Table II.

Patient domains of successful smoking cessation

Domain	Summary of domain	Key quotes
Patient motivation	Long-term smokers Know smoking is harmful now they should quit smoking Often have tried to quit multiple times Successfully quitting requires a tipping point: Often a major life event Forces the patient to prioritize quitting	“Sure, I quit, but can I spend the rest of my life every day craving something? Yeah, because I’m not going to have a life if I don’t quit.” “It’s got to be a wakeup call but logic doesn’t work.” “The cigarettes are more of a priority than anything. Until you change the priority, it’s not going to change anything.”
Physician tone in counseling	Successful aspects of physician advice: Brief advice (no lecture) Compassionate tone Encouragement of small steps Emphasizes the positive aspects (quitting will help you play with grandchildren, etc) Physician advice can be counterproductive: Scolding or accusatory toward patient Imply quid-pro-quo (we’re going to place a stent, so you should quit)	“If you make me feel like I’m not trying hard enough or you’re rude about it, I’m going to walk out and say bye and have a cigarette and won’t see them again.” “Encouragement as opposed to belittling you like you’re dumb. You had all this stuff and smoking isn’t helping and you can’t quit.” “[a good physician] says he understands and he wants me to try to quit but he understands how hard it is and if I just keep working on it that would be good. I won’t quit trying to quit.” “You’re telling this guy he’s going to have his leg cut off and he’s got all these problems and ‘ If you don’t put the damn cigarette down, that’s the problem.’ That’s not the way.”
Individualized program	Make a variety of options available Different options work for different patients Make all options accessible regardless of patient education level	“I think something will work for everybody. It’s just that it’s so individualized. They’ve got to find that one for them.” “Hey, how do you feel about this and this?” instead of handing them a booklet saying, “Fill this out.”
Timing of the attempt	Physicians should be mindful of when smoking cessation is discussed: Not after a new diagnosis Patients mentioned after a successful procedure or hospitalization might be best	“Not when I was first diagnosed. I’m already scared.” “If the blood’s running good and everything’s going great and the surgery went fine, now if I quit smoking, … it’s going to prolong it happening again and for me, that was the time to say, okay, he’s done everything he could do.” Me personally, right out of surgery is the worst time. I was better, just before surgery for me.