Stage of Change: Action
This patient is in the Action stage of smoking cessation. 1
Rationale for Stage Classification
The patient has already taken concrete steps toward quitting by:
- Purchasing a nicotine patch (demonstrating active preparation and commitment beyond mere planning) 1
- Presenting to a smoking cessation clinic (actively seeking professional support) 1
- Expressing willingness to quit (demonstrating readiness for immediate behavior change) 1
Understanding the Stages of Change Model
The stages of change for smoking cessation progress as follows 1:
- Precontemplation: No intention to quit smoking; patient is not considering cessation 1, 2
- Contemplation: Thinking about quitting but not ready to take action; characterized by ambivalence 1, 2
- Preparation: Planning to quit soon (typically within 30 days) and beginning to take small steps toward cessation 1
- Action: Actively modifying behavior and implementing the quit plan; this stage lasts from quit date through the first 6 months of abstinence 1
- Maintenance: Sustained abstinence beyond 6 months; focus shifts to relapse prevention 1
Why This Patient is in Action Stage
The purchase of nicotine patches represents active behavior modification, not just preparation. 1 While the Preparation stage involves planning and setting a quit date, the Action stage is characterized by implementing pharmacotherapy and actively engaging with cessation resources 1, 3. This patient has moved beyond contemplation (44% of smokers) and preparation (14% of smokers) into active implementation 2.
Clinical Implications for Action Stage Patients
For patients in the Action stage, physicians should 3:
- Provide strong support and reinforcement for the quit attempt 3
- Ensure proper use of the nicotine patch: Standard dosing is 21 mg/24-hour patch for smokers of >10 cigarettes/day, with step-down dosing over 8 weeks 4
- Combine pharmacotherapy with behavioral counseling: This combination achieves 15.2% quit rates versus 8.6% with brief advice alone 5
- Schedule follow-up within 2-3 weeks after starting pharmacotherapy to assess smoking status and medication tolerability 5, 4
- Consider combination NRT (patch plus short-acting form like gum or lozenge) for optimal effectiveness, with relative risk of 1.25 for higher long-term quit rates 4, 6
Common Pitfall to Avoid
Do not confuse the Preparation stage with the Action stage. While preparation involves planning and acquiring resources, the Action stage begins when the patient actively implements the quit plan with pharmacotherapy and behavioral modification 1. This patient's purchase and clinic visit represent active implementation, not just preparation.