How can I assess a patient's readiness to quit smoking during a consultation?

To assess a patient's readiness to quit smoking during a consultation, start by asking if they currently smoke or have recently stopped smoking at every opportunity in a sensitive manner tailored to their preferences and needs. This initial enquiry helps identify smokers and opens the conversation about quitting ².

Next, deliver very brief advice (VBA) using the Ask, Advise, Act model: Ask about smoking status, Advise that stopping smoking is best achieved through a combination of behavioural support and medication, and Act by offering help such as referral to local NHS stop smoking services or prescribing cessation treatments ¹.

Assess nicotine dependence using key indicators such as how soon after waking the patient smokes their first cigarette and the number of cigarettes smoked per day. This can be quantified using the Fagerström Test for Cigarette Dependence (FTCD) or simpler scoring based on these two questions, which helps predict withdrawal severity and tailor support ¹.

Ask about previous quit attempts, including their success, treatments used, and experiences of withdrawal symptoms and cravings, to understand motivation and barriers ¹.

Consider measuring carbon monoxide (CO) levels in expired air to validate smoking status and provide a baseline; a CO reading above 10 ppm indicates current smoking ¹.

Discuss any barriers to quitting the patient may have, such as stress, and explore enablers like family support or health benefits, to gauge readiness and tailor advice ¹.

For patients not ready to quit immediately, encourage them to think about quitting and discuss harm reduction approaches, recording their smoking status and revisiting the conversation at future contacts ¹.