Asking with respect shows you care and are someone your patient can talk to. Even if they’re not ready to quit right away, you can plant the seed to get them thinking about it. It may take several conversations to open the door to a nicotine cessation attempt (UpToDate).

✅ Ask open-ended questions to create a supportive atmosphere and assess their readiness to quit.

🗣️ For patients who respond that they use tobacco or nicotine, try to begin a conversation.

Example questions:

• “Do you mind talking about your smoking?” (or “your vaping” or “your use of nicotine products”)
• “How do you feel about your tobacco use currently?”
• “Have you thought about quitting? or tried to quit?”
• “What would be different about your life if you did quit?”

In a confident and empathetic manner, recommend the patient seek tobacco cessation support.

➡️ Ask permission to share information. “Would it be okay if I shared info...?“

• If response is 'yes', then utilize the resources under the Connect dropdown section on this page, including referring them to the WA State Quitline.
• If a patient says they don’t want to quit, briefly let them know about quit resources and that you're there for support when/if they choose to do so.

➡️ Acknowledge the challenges of quitting nicotine.

Enhance communication efforts. Keep conversations open.

• Frame with empathy. Be supportive of a patient’s efforts to quit.
• Prioritize audience. Focus on tobacco use as chronic disease management through persistent quit attempts.
• Use culturally and linguistically appropriate materials.
• Social stigma about tobacco use is high. Avoid language and reactions that could make your patient less likely to seek help and less likely to quit.

A slip or relapse is an opportunity to obtain information and reflect on triggers and patterns.

• Ask yourself: What barriers is the patient experiencing? How can we reduce them?
• Previous quit attempts build momentum toward a successful and long-term quit.

Resources:

• Tips from Former Smokers for Specific Groups (CDC): provides data, personal stories, and materials in different languages.
• ALA Quick Reference Guide: Why It’s Hard to Quit: Emphasizes that most people are motivated to quit, but it is difficult. It's important to plan for physical, psychological, and sociocultural challenges and to consider using combination therapy.
• King County Training for Healthcare Providers: Learn about Motivational Interviewing techniques to help people quit nicotine.

Research shows that individuals who use a combination of counseling (like a quitline or group program) and medication (like nicotine-replacement therapy) are more likely to successfully quit for good (2020 Surgeon General Report). Most importantly, encourage your patients to use a cessation method that they are comfortable with.

✅ For Patients Who are Ready to Quit:

Encourage them to create a quit plan. Discuss these steps:

• Set a quit date.
• Remove commercial tobacco products from their environment.
• Get support from family, friends, and co-workers.
• Anticipate potential challenges, especially during the first few weeks.
• Recommend this online tool: Making A Quit Plan on smokefree.gov

Connect them with cessation coaching services, either within your healthcare facility (if available), or through the Washington State Tobacco Quitline.

➡️ Washington State Tobacco Quitline: 1-800-QUIT-NOW

• Call (1-800-784-8669) or text READY to 200-400
• Visit https://quitnow.net/washington
• En Espanol: 1-855-DEJELO-YA (1-855-335-3569)
• Available 24-7

➡️ Discuss using a nicotine replacement medication.

• Learn about NRTs and Prescribing Guidelines: Toolkit to Implement Tobacco Treatment in Oncology Settings

✅ Overview of WA Quitline services

All Washington residents are eligible for free phone counseling and text message support through the Tobacco Quitline. Quitline staff may be able to identify face-to-face counseling programs.

The Tobacco Quitline has tailored services for people who are Alaskan Indian/American Native, people who are pregnant, people with a behavioral health condition, people who smoke menthol cigarettes, and people who are 18-26 and vape.

The Tobacco Quitline is provided in English and Spanish. Quitline staff also utilize third party translators for these languages: French, Cantonese, Mandarin, Korean, Vietnamese, Russian, Greek, Amharic (Ethiopian), and Punjabi.

• DOH summary table “Current Coverage, by Insurance Status”

✅ For patients who are trying to quit:

• Make a follow-up appointment (in-person/virtual)
• Ask your patient: "What is working with your efforts to stop using tobacco products? What isn’t working?"
• Address relapses and slips with support and problem-solving.

For patients using NRTs:

• Ask if they are experiencing side effects.
• Ask questions to understand if the patient is using the NRT correctly.
• Suggest a different NRT, if needed. (get source)
• More information about NRTs (link to subpage)

✅ For patients who aren’t ready to quit:

• Make a note to follow up with the Ask and Advise process at their next appointment.
• Don’t be discouraged, this patient isn’t ready today, but they may be ready to quit in the future.