A patient who declines to make a quit attempt may have reasons for not quitting that she is unable or unwilling to express. Or, she may think smoking risks do not apply to her. The 5 R’s are useful for identifying issues that are of most concern to the patient who is reluctant to try to quit. Motivational interventions are most likely to be successful when the clinician is empathetic, promotes patient autonomy (ie, choice among options), avoids arguments, and supports the patient’s self-efficacy—for example, by reminding her of previous successes in behavior change efforts. It is not necessary to cover all of the 5 R’s at each patient visit.
Colby SM, Barnett NP, Monti PM, et al. Brief motivational interviewing in a hospital setting for adolescent smoking: a preliminary study. J Consult Con Psychol 1999;66:574–578.
Miller W, Rolnick S. Motivational interviewing: preparing people to change addictive behavior. New York: Guilford, 1991.
Prochaska J, Goldstein MG. Process of smoking cessation. Implication for clinicians. Clin Chest Med 1991;12:727–735.