smoking%20cessation
SMOKING CESSATION
Ask, Advise to quit and Assess are the steps in approaching patients regarding smoking cessation.
All patients should be asked if they use tobacco and should have their tobacco status documented on a regular basis.
Patient with nicotine dependence is characterized by smoking within 30 minutes of waking, consuming >10 cigarettes/day and had withdrawal symptoms in previous attempts of quitting smoking.
Smokers should be strongly urged to quit at every physician encounter. 
Advice should be clear, personalized, supportive and non-judgmental.
Determine the willingness of smoker to make a quit attempt.

Assessment

  • Assess patient’s willingness to stop and ability to adapt to smoking cessation interventions prior to conduction of therapies
  • Determine the willingness of smoker to make a quit attempt
    • Patient in the precontemplation stage, where he is not willing to quit or has not thought about quitting, should be provided with motivation to quit
    • Patient in the contemplation stage, where he has thought about stopping but has not made a decision to quit, should be provided with motivation to quit as well
    • Patient in preparation stage, where he has thought of quitting within the next 30 days and has already made changes such as cutting back
  • Patient is in action stage when he already stopped smoking within the last 6 months, and is in the maintenance stage if patient has adapted to smoking cessation therapies for >6 months
  • For patients willing to quit within the next 30 days, set a quit date and create an individualized quit plan, continue smoking cessation counseling and discuss risk of relapse 
  • For patients not willing to quit within the next 30 days, address patient’s concerns, consider decreasing amount of smoking and aim to set a quit date 
    • Assess level of motivation

Screening

Screen for Tobacco Use

  • All patients should be asked if they use tobacco and should have their tobacco status documented on a regular basis
    • Check on changes in patient’s smoking status, quit attempts and interventions applied
    • Patient with nicotine dependence is characterized by smoking within 30 minutes of waking, waking at night to smoke, smoking despite an illness, consuming >10 cigarettes/day, had withdrawal symptoms in previous attempts of quitting smoking, and had to smoke to decrease withdrawal symptoms
    • May use questionnaires (eg CAGE questionnaire, Fagerstrom test, four Cs test) to assess level of tobacco dependence
  • Evidence shows that this significantly increases clinician intervention
  • Patient in maintenance stage, where he has stopped smoking for at least 6 months, should be assisted in preventing relapse
    • May still be vulnerable to relapse up to 1 year
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