Stage of Change: Preparation Stage
This patient is in the Preparation Stage of smoking cessation, characterized by willingness to quit and taking concrete action (purchasing nicotine patches) to prepare for a quit attempt. 1, 2
Understanding the Stages of Change Model
The smoking cessation process involves progression through five distinct stages 2:
- Precontemplation: Not considering quitting
- Contemplation: Thinking about quitting but not ready to act
- Preparation: Ready to quit and taking steps toward action (this patient's stage)
- Action: Actively quitting (first 6 months of abstinence)
- Maintenance: Sustained abstinence beyond 6 months
Why This Patient is in the Preparation Stage
The patient demonstrates two key characteristics that define the Preparation Stage 2:
- Expressed willingness to quit: The patient came to the clinic specifically for smoking cessation, indicating motivation and readiness 1
- Taking concrete preparatory action: Purchasing a nicotine patch represents tangible preparation for a quit attempt, which is the hallmark behavior of this stage 3, 2
Clinical Implications for This Stage
Patients in the Preparation Stage require different interventions than those in earlier stages 2:
- Behavioral interventions are most effective now: Providing substitutes like nicotine patches, removing smoking cues, and setting a specific quit date are appropriate for patients ready to take action 2
- Action-oriented programs work best: Most formal smoking cessation programs are designed specifically for patients in the Preparation or Action stages 2
- Prognosis is favorable: Patients who reach the Preparation Stage have doubled their chances of not smoking 6 months later compared to those in earlier stages 2
Optimal Management at This Stage
The preparation phase aims to build confidence and set up conditions for successful cessation 3:
- Set a specific quit date: Establish a target quit day (TQD) within the next 1-2 weeks 4, 5
- Optimize nicotine replacement therapy: For smokers of ≥10 cigarettes/day, start with a 21 mg/24-hour patch combined with a short-acting NRT form (gum, lozenge, or spray) as combination therapy nearly doubles quit rates (36.5% vs 23.4% abstinence at 6 months, RR 1.25,95% CI 1.15-1.36) 6, 7
- Consider pre-cessation nicotine patch use: Starting the patch 2 weeks before the quit date while still smoking increases quit rates by 25% (RR 1.25,95% CI 1.08-1.44), particularly beneficial for smokers with lower nicotine dependence 8, 7
- Provide preparation counseling: This significantly improves 16-week abstinence rates and should focus on building quit skills, identifying triggers, and developing coping strategies 5
- Schedule early follow-up: Plan the first follow-up within 2 weeks after starting pharmacotherapy to monitor adherence and address any issues 6
Common Pitfall to Avoid
Do not assume the patient understands proper NRT use simply because they purchased patches 8, 7:
- Many patients use inadequate doses or discontinue therapy prematurely 7
- Proper education about combining patch with short-acting NRT and maintaining therapy for at least 12 weeks is essential 6, 7
- Without behavioral support, even motivated patients have lower success rates—combining pharmacotherapy with counseling increases quit rates from 8.6% to 15.2% 7