Smoking cessation

Ask: systems should be established in each clinic that identify the smoking status of each patient and that communicate this status to physicians.

Advise: a personalised, open, and reflective patient-centred discussion should be provided on how smoking cessation can help patients achieve their goals.

Assess: it should be determined whether patients are ready to consider attempting to stop and, if ready, how confident they are about success.

Assist: for those not yet ready to attempt stopping, communication lines should be kept open for motivational messages, to let them know help is available when they are ready. For those who are ready, a menu of available pharmacotherapy and counselling options should be provided. First-line pharmacotherapy doubles the success rate of a stopping attempt.

Arrange follow-up: patients should be connected with a counselling follow-up within a week of their stopping date. This can be with a telephone counselling line, with face-to-face group or individual counselling, or with return clinic visits or telephone calls from the clinic.

Cigarette smoking is the most common cause of preventable death and disease.[1]Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States, 2000. JAMA. 2004 Mar 10;291(10):1238-45. http://www.ncbi.nlm.nih.gov/pubmed/15010446?tool=bestpractice.com Physicians and other healthcare professionals should play a central role in motivating and assisting patients who smoke to stop.[2]Fiore MC, Jaén CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. May 2008 [internet publication]. http://www.ncbi.nlm.nih.gov/books/NBK63952/ Physicians are a credible and trusted source of advice to stop, have opportunities to provide this message to most smokers, and can connect patients to cessation counselling and pharmacotherapy. These actions are economical and effective at increasing cessation rates.[3]Maciosek M, Coffield A, Edwards N, et al. Priorities among effective clinical preventive services: results of a systematic review and analysis. Am J Prev Med. 2006;31:52-61. http://www.ncbi.nlm.nih.gov/pubmed/16777543?tool=bestpractice.com