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A word to the wise: quick guide to quitting smoking

Gill Mitchell
Counsellor and Service Manager

Every day over 300 people in the UK die of a smoking-related illness. Yet smoking is the most preventable cause of disease and premature death in this country.
Seventy percent of smokers want to stop but may not be ready to do so, or they may be unaware of available methods of quitting.
Nurses are ideally placed to reassure patients about their fears of quitting smoking and advise them of what to expect.

Withdrawal symptoms
Smokers are often concerned about the symptoms they will experience as a result of nicotine withdrawal. Symptoms can include irritability, restlessness, depression, difficulty concentrating, sleep disturbance, increased appetite and craving for tobacco. The good news is that these signs mean the body is slowly recovering. All the symptoms are temporary and, unlike smoking, none of them is life-threatening.

Does nicotine cause cancer?
Many smokers believe it is nicotine that causes the cancer. This is, of course, incorrect; when a person lights up, nicotine gives them the hit, but the rest of the smoke does the damage. There are over 4,000 chemicals in cigarette smoke, including formaldehyde, ammonia and cadmium. Nicotine is not one of the cancer-causing agents. It is simply the reason you crave a cigarette. Nicotine in nicotine replacement therapy (NRT) can actually help with the attempt to quit smoking.

The five As
When helping smokers, the national guidelines recommend nurses should follow the five As: Ask, Advise, Assess, Assist and Arrange.(1)

Screen for smoking status at every visit or admission.


  • Minimal advice would be: "I must advise you that smoking is bad for your health, and it would be important for you to stop."
  • Augmented advice: "Because of your (__________) condition, it is particularly important for you to stop. If you stop now, (briefly educate patient about basic health benefits from quitting)."


  • Minimal assessment: ask every tobacco user if he/she is willing to make a quit attempt at this time.
  • Augmented assessment: assess characteristics of smoking history and patterns with the following:

    - Amount smoked.
    - Quit history.

  • Stage of change:

Precontemplator: is not seriously considering stopping smoking.
Contemplator: is seriously considering stopping within 3-6 months.
Preparation: is seriously considering stopping within the next week to month, and has already made changes such as cutting back.
Action: has recently stopped smoking (within last six months).
Relapse: has quit for at least 48 hours but is smoking again. Maintenance: has quit for at least six months, but may still be vulnerable to a relapse up to one year.


  • Minimal assistance: provide self-help materials; assess interest in quitting; assess interest in and appropriateness of pharmacological aids.
  • Augmented assistance: provide brief 5-7-minute patient-centred counselling. See Box 1 for an outline of the counselling content.


Arrange follow-up support

  • Minimal follow-up support: arrange for single follow-up contact by visit or by telephone in about two weeks; provide referral to a smoking counsellor or group.
  • Extended follow-up support: establish "quit smoking" contract with quit date. Arrange three or more follow-up contacts by visit or by telephone.

Patients should be advised to ring Quitline 0800 00 22 00 or email for help from a QUIT counsellor. We can also let smokers know where the nearest stop smoking group is.
If you feel you'd like more support in helping smokers to stop, QUIT runs training courses aimed at three different levels for health professionals. The charity also runs courses on specific topics and for key groups. Details of a wide range of stop smoking courses can be found at For information on training, email or call 0207 251 1551 and ask to speak to a member of the training team.


  1. National Cancer Institute. Prevention and cessation of cigarette smoking: control of tobacco use. Available from: net/310742.html