A 70-year-old with a 30 pack-year history of smoking and controlled hypertension gives no indication of wanting to quit. Which stage of change is he in?

Correct answer: A. Precontemplation

• A. CORRECT. In the Transtheoretical (Stages of Change) model, PRECONTEMPLATION describes a person who is not considering change within the next 6 months and may be unaware of, or resistant to, the problem. The appropriate intervention is to raise awareness — provide personalized information, express concern, and leave the door open — NOT to hand over a quit plan the patient did not ask for.
• B. Contemplation means the person is ambivalent and considering change within 6 months; this patient has not expressed that.
• C. Action means the person has actively changed behavior within the past 6 months.
• D. Preparation means the person intends to act within 30 days and has often already taken a small step.

Note: The 5 A's: Ask, Advise, Assess, Assist, Arrange. In precontemplation you deliver Ask/Advise/Assess and stop — pushing Assist prematurely creates resistance.