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. Studies have shown that unplanned efforts to quit is as successful as planned attempts, stressing the benefits in encouraging smokers to quit smoking whenever opportunity arises.
Advice should be clear, personalized, supportive and non-judgmental.
Determine the willingness of smoker to make a quit attempt.
Patient is in action stage when he already stopped smoking within the last 6 months.

Lifestyle Modification

Reasons Patient May be Unwilling to Quit

  • Lack of information regarding the benefits of quitting & the harmful effects of tobacco (ie cancer, stroke, cardiovascular diseases, & chronic pulmonary diseases)
  • Previous failed attempts may have demoralized patient
    • Severe withdrawal symptoms during previous quit attempts
  • Presence of other tobacco users in home or workplace
  • Lack of required resources
  • Fear/concerns regarding quitting (eg fear of weight loss, fear of losing benefits or function of smoking such as overcoming feelings of boredom, stress, anxiety)

Motivational Intervention

  • An approach that enhances patients’ motivation to quit smoking
  • Composed of 5 components:
    • Relevance - Patient to indicate why quitting is personally relevant
    • Risks - Ask patient to identify potential negative consequences of smoking
    • Rewards - Patient should realize & understand the potential benefits of quitting
    • Roadblocks - Ask patient to identify barriers to quitting & note actions to address the barriers
    • Repetition - Patient’s current motivation to quit should be asked every patient visit
  • Motivational intervention will be more successful if the clinician is empathetic, promotes patient autonomy, supports the patient’s self-efficacy & avoids arguments
  • Patients who have failed in previous attempts to quit should be informed that most people make repeated failed attempts before they have succeeded
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