Situation: A 55-year-old woman is scheduled for an elective open cholecystectomy in 4 weeks. At the preoperative clinic visit, she reports smoking 10 cigarettes a day for 20 years. She has type 2 diabetes controlled with metformin. She works as a bookkeeper and says she learns best by doing. The nurse advises her to stop smoking before surgery. She replies, "I know I should quit, and I plan to stop within the next 3 months, but I am not ready to set a date this month." According to the Transtheoretical Model, which stage of change is she in?

Contemplation is intending to change within the next 6 months while still weighing pros and cons. Preparation requires intending to act within the next month, usually with a plan such as a quit date, which she has declined. Precontemplation means no intention within 6 months, and action means she has already changed.

Stage of Change: Contemplation

The client’s statement places her squarely in the Contemplation stage of the Transtheoretical Model (TTM). She acknowledges the need to quit (“I know I should quit”), expresses an intention to act within a defined future window (“within the next 3 months”), but explicitly declines to commit to a concrete start date this month. This pattern—intending to change within the next 6 months while still weighing the pros and cons and avoiding immediate commitment—is the defining feature of Contemplation .

The critical discriminator between Contemplation and Preparation is the time frame for intended action: within the next 6 months versus within the next 30 days, with a concrete plan. Her stated 3-month window falls inside the 6-month boundary for Contemplation, but her refusal to set a quit date this month excludes Preparation. Preparation requires not only intention but also a behavioral commitment such as a quit date, reduced smoking, or prior quit attempts within the past year .

Stage	Intention to act	Key behavioral markers	This client
Precontemplation	No intention within 6 months	Unaware or defensive; not considering change	No—she acknowledges need to quit
Contemplation	Within 6 months	Weighing pros and cons; ambivalent; no firm plan	Yes—3-month intention, no quit date
Preparation	Within 30 days	Has a quit date or small behavioral steps already taken	No—declines to set a date this month
Action	Current change	Has already stopped smoking (less than 6 months)	No—still smoking 10 cigarettes/day

Key point! The TTM is a cyclical, not linear, model. Individuals typically recycle through stages several times before achieving stable cessation . A client in Contemplation may move back to Precontemplation under stress or forward to Preparation when decisional balance shifts. The nurse’s role is not to push for immediate action but to help the client explore ambivalence and strengthen the pros of quitting relative to the cons—a process the TTM calls decisional balance .

Watch out! Do not confuse “I plan to stop within 3 months” with Preparation. Preparation requires a 30-day intention plus a concrete plan. A 3-month intention without a quit date is still Contemplation. Also, her type 2 diabetes and upcoming surgery do not change the stage classification; staging is based solely on the client’s self-reported intention and behavior, not on clinical urgency .

In the preoperative context, this distinction matters because smoking cessation interventions are most effective when matched to the client’s stage. A client in Contemplation benefits from information about surgical risks of smoking and exploration of personal reasons for quitting, rather than being handed a quit date prematurely . The nurse can acknowledge the client’s awareness and ask what would help her feel ready to set a date—moving her toward Preparation without forcing the transition.