Enhancing motivation to quit tobacco -- the "5 R's" For patients not ready to make a quit attempt at this time, clinicians should use a brief intervention designed to increase motivation to quit. Patients unwilling to make a quit attempt during a visit may lack information about the harmful effects of tobacco, may lack the required financial resources, may have fears or concerns about quitting, or may be demoralized because of previous relapse. Such patients may respond to a motivational intervention to educate, reassure, and motivate, such as the "5 R's": relevance, risks, rewards, roadblocks, and repetition. Clinical components of the "5 R's" are shown below. Motivational interventions are most likely to be successful when the clinician is empathic, promotes patient autonomy (e.g., choice among options), avoids arguments, and supports the patient's self-efficacy (e.g., by identifying previous successes in behavior change efforts).
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, age, gender, and other important patient characteristics (e.g., prior quitting experience, personal barriers to cessation).
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:
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 follow:
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:
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.