Contemplation Stage

DHP: "Hi Kim, thanks for filling out the Tobacco Use Assessment Form. Looking at your answers I see you are currently smoking a pack and a half a day and that you are interested in quitting."

Pt: "I would like to quit. Smoking is not doing me any good that's for sure."

DHP: "I'm glad to hear you are interested in quitting. Why do you want to quit?"

Pt: "Well, I have a two-year old daughter and I've read about the effect secondhand smoke could have on her and, of course, I want to be a good role model too. I'm also a little concerned about my own health. My dad was a smoker and now he has emphysema real bad."

DHP: "Those are all good reasons! How long have you been smoking a pack and a half a day?"

Pt: "Oh, for about 15 years."

DHP: "You indicated on the assessment form your first cigarette is fairly soon after you wake up?"

Pt: "It is the first thing I do."

DHP:
"Have you tried to quit in the past?"

Pt: "Yes, I have tried a couple of times. When I was pregnant and the last time I tried to quit was about six months ago."

DHP: "What strategy did you use to quit?"

Pt: "I did it cold turkey. I didn't want to hurt my child when I was pregnant and I decided I didn't want cigarettes to control me for the rest of my life."

DHP:
"What was the longest time you went tobacco free?"

Pt: "Almost 2 months."

DHP: "What got you started smoking again?"

Pt: "A very stressful project at work. That's what worries me. I don't have much confidence in myself as far as quitting is concerned and I'm afraid I will just fail again."

DHP: "So you want to quit, you have some very good reasons to quit, but you are afraid you can't succeed."

Pt: "That's right, I know I should quit, but I know how difficult it was to quit before."

DHP:
"Well I'm encouraged you have tried a couple times and you were able to quit for as long as two months. That is very positive. It's rather common for a lot of smokers to have several quit attempts before they succeed. If you are willing to keep trying, your next one may be successful"

Pt: "I certainly hope so."

DHP: "Let's see now, our oral exam revealed you have periodontal disease. As you recall, I explained that process and recommended treatment for you.

We also discussed the fact that smoking is a major factor in the onset and progression of this disease. The best thing you could do to improve the results of your treatment and give you the best chance of long-term oral health would be for you to become tobacco-free."

Pt: "Well I sure want to keep my teeth. That is another good reason for me to quit, but I don't know the best way to go about it."

DHP:
"Many people who quit smoking don't do enough planning before their quit date. They fail to plan for how they will cope with the triggers, or cues to their cigarette use. Furthermore, many people don't look at the daily routines and rituals they will need to change during this period of time.

If you are interested, I will give you some pamphlets you can read and think about. They include information on coping strategies, withdrawal symptoms, stress management, and helpful tips on quitting."

You might also consider some group or individual tobacco cessation programs and helplines. I can give you a list of local programs with their phone numbers so you can contact them if you want more information, or help in your quit attempt."

Pt: "I would like to look at the information. I'm not so sure about the group programs. I might consider the helpline approach and possibly a more intense counseling program later, depending on how I do."

DHP: "Do you know anyone who has used any of the stop smoking aids like the nicotine gum or patch, or the pill Zyban?"

Pt: "I do know a co-worker that was able to quit using a nicotine patch."

DHP:
"That individual may be a good person to support you in your quit attempt. A nicotine replacement product, or a combination of nicotine replacement products would be helpful in your case. Let's plan to see you for a series of treatment appointments. After you have had a chance to look at the self-help pamphlets and think about your quit plans, we can talk about the stop smoking pharmaceutical options. I will give you some printed material on these products.

If it is OK with you, I would like to keep in touch with you to see how you are doing."

Pt: "Good, I will think about what you have said. I don't think I am quite ready to quit yet, but this information will help me with the decision. I really appreciate your help and concern."

This example of a brief intervention with a patient in the contemplation stage of change also includes raising their awareness of the general and oral health benefits of a tobacco free lifestyle. One can assist patients by providing self-help materials and a list of local programs helps them to think about and plan for their next quit attempt. Helping patients to gain confidence can be done by being positive about their previous attempts and letting them know it takes many people a number of quit attempts before they are successful.

The contemplator is ambivalent and not ready to set a quit date now, but a positive brief intervention may help him or her to move on to the next stage. Contemplators must become more and more aware of the disadvantages of the old behavior and the advantages of change. Letting the patient know you are supportive and want to see them succeed can be very important.

DHP:	"Hi Kim, thanks for filling out the Tobacco Use Assessment Form. Looking at your answers I see you are currently smoking a pack and a half a day and that you are interested in quitting."
Pt:	"I would like to quit. Smoking is not doing me any good that's for sure."
DHP:	"I'm glad to hear you are interested in quitting. Why do you want to quit?"
Pt:	"Well, I have a two-year old daughter and I've read about the effect secondhand smoke could have on her and, of course, I want to be a good role model too. I'm also a little concerned about my own health. My dad was a smoker and now he has emphysema real bad."
DHP:	"Those are all good reasons! How long have you been smoking a pack and a half a day?"
Pt:	"Oh, for about 15 years."
DHP:	"You indicated on the assessment form your first cigarette is fairly soon after you wake up?"
Pt:	"It is the first thing I do."
DHP:	"Have you tried to quit in the past?"
Pt:	"Yes, I have tried a couple of times. When I was pregnant and the last time I tried to quit was about six months ago."
DHP:	"What strategy did you use to quit?"
Pt:	"I did it cold turkey. I didn't want to hurt my child when I was pregnant and I decided I didn't want cigarettes to control me for the rest of my life."
DHP:	"What was the longest time you went tobacco free?"
Pt:	"Almost 2 months."
DHP:	"What got you started smoking again?"
Pt:	"A very stressful project at work. That's what worries me. I don't have much confidence in myself as far as quitting is concerned and I'm afraid I will just fail again."
DHP:	"So you want to quit, you have some very good reasons to quit, but you are afraid you can't succeed."
Pt:	"That's right, I know I should quit, but I know how difficult it was to quit before."
DHP:	"Well I'm encouraged you have tried a couple times and you were able to quit for as long as two months. That is very positive. It's rather common for a lot of smokers to have several quit attempts before they succeed. If you are willing to keep trying, your next one may be successful"
Pt:	"I certainly hope so."
DHP:	"Let's see now, our oral exam revealed you have periodontal disease. As you recall, I explained that process and recommended treatment for you. We also discussed the fact that smoking is a major factor in the onset and progression of this disease. The best thing you could do to improve the results of your treatment and give you the best chance of long-term oral health would be for you to become tobacco-free."
Pt:	"Well I sure want to keep my teeth. That is another good reason for me to quit, but I don't know the best way to go about it."
DHP:	"Many people who quit smoking don't do enough planning before their quit date. They fail to plan for how they will cope with the triggers, or cues to their cigarette use. Furthermore, many people don't look at the daily routines and rituals they will need to change during this period of time. If you are interested, I will give you some pamphlets you can read and think about. They include information on coping strategies, withdrawal symptoms, stress management, and helpful tips on quitting." You might also consider some group or individual tobacco cessation programs and helplines. I can give you a list of local programs with their phone numbers so you can contact them if you want more information, or help in your quit attempt."
Pt:	"I would like to look at the information. I'm not so sure about the group programs. I might consider the helpline approach and possibly a more intense counseling program later, depending on how I do."
DHP:	"Do you know anyone who has used any of the stop smoking aids like the nicotine gum or patch, or the pill Zyban?"
Pt:	"I do know a co-worker that was able to quit using a nicotine patch."
DHP:	"That individual may be a good person to support you in your quit attempt. A nicotine replacement product, or a combination of nicotine replacement products would be helpful in your case. Let's plan to see you for a series of treatment appointments. After you have had a chance to look at the self-help pamphlets and think about your quit plans, we can talk about the stop smoking pharmaceutical options. I will give you some printed material on these products. If it is OK with you, I would like to keep in touch with you to see how you are doing."
Pt:	"Good, I will think about what you have said. I don't think I am quite ready to quit yet, but this information will help me with the decision. I really appreciate your help and concern."