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 personalized, open, and reflective patient-centered 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 quit and, if ready, how confident they are about success.
Assist: for those not yet ready to attempt quitting, 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 counseling options should be provided. First-line pharmacotherapy doubles the success rate of a quit attempt.
Arrange follow-up: patients should be connected with a counseling follow-up within a week of their quit date. This can be with a telephone counseling quit line, with face-to-face group or individual counseling, or with return clinic visits or telephone calls from the clinic.
Cigarette smoking is the most common cause of preventable death and disease. Physicians and other healthcare professionals should play a central role in motivating and assisting patients who smoke to quit. Physicians are a credible and trusted source of advice to quit, have opportunities to provide this message to most smokers, and can connect patients to cessation counseling and pharmacotherapy. These actions are economical and effective at increasing cessation rates.
History and exam
Key diagnostic factors
- number of cigarettes per day
- time to first cigarette (TTFC) ≤30 minutes or >30 minutes
- polysubstance abuse
- smokeless tobacco user
- seizure disorder
- pregnancy or breastfeeding
Other diagnostic factors
- history of depression
- history of schizophrenia
- unstable cardiac disease
- ventricular arrhythmia
- temporomandibular joint or dental disorder
- smokeless tobacco user
1st investigations to order
- no tests required
hospitalized active smokers
active smokers ready to quit: adults (no pregnancy, breastfeeding, depression, or polysubstance abuse)
active smokers ready to quit: pregnant/breastfeeding women, adolescents
active smokers ready to quit: depression and smoking cessation
active smokers ready to quit: polysubstance abuse and smoking cessation
active smokers not ready to quit
smokeless tobacco users
- Polysubstance abuse
- NCCN clinical practice guidelines in oncology: smoking cessation
- Integrating tobacco interventions into daily practice
Quitting smokingMore Patient leaflets
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