Assisting Patients with Quitting

Question 1

Non-pharmacological Methods

Answer 1

• Cold turkey: Just do it!
• Unassisted tapering (fading): reduced frequency of use, lower nicotine cigarettes, special filters or holders
• Assisted tapering: QuitKey (computer developed taper based on patient’s smoking level, includes telephone counseling support)
• Formal cessation programs: self-help programs, individual counseling, group programs, telephone counseling, web-based counseling
• Acupuncture therapy
• Hypnotherapy
• Massage therapy

Question 2

The 5 A’s

Answer 2

• ASK
• ADVISE
• ASSESS
• ASSIST
• ARRANGE

Question 3

ASK

Answer 3

• Ask about tobacco use; with a tone that conveys sensitivity, concern and is non-judgmental:
• EX:“Do you smoke or use other types of tobacco or nicotine, such as e-cigarettes?”

Question 4

ADVISE

Answer 4

• Advise tobacco users to quit (clear, strong, personalized)

- EX: “It’s important for your health that you quit smoking, and I can help you.”

Question 5

ASSESS

Answer 5

• Assess readiness to make a quit attempt

Question 6

ASSIST

Answer 6

• Assist with the quit attempt
• Not ready to quit: enhance motivation (the 5 R’s)
• Ready to quit: design a treatment plan
• Recently quit: relapse prevention

Question 7

ARRANGE

Answer 7

• Arrange follow-up care

- Provide assistance throughout the quit attempt

Question 8

Assessing Readiness to Quit

Answer 8

• Stage 1: Not ready to quit in the next month
• Stage 2: Ready to quit in the next month
• Stage 3: Recent quitter, quit within past 6 months
• Stage 4: Former tobacco user, quit > 6 months ago

Question 9

STAGE 1: NOT READY to QUIT

Answer 9

GOAL: Start thinking about quitting.

DO

• Strongly advise to quit
• Provide information
• Ask noninvasive questions; identify reasons for tobacco use
• Raise awareness of health consequences
• Demonstrate empathy, foster communication
• Leave decision up to patient

DONT
- Persuade, cheerlead, be judgmental, provide tx plan

The 5 R’s—Methods for enhancing motivation:

• Relevance
• Risks
• Rewards
• Roadblocks
• Repetition

Question 10

STAGE 2: Ready to Quit

Answer 10

GOAL: Achieve cessation.

• Assess tobacco use history
• Discuss key issues
• Facilitate quitting process (practical counseling, social support tx)
• Praise the patient’s readiness
• Assess tobacco use history (current use, past use, past quit attempts)
• Reasons/motivation to quit
• Confidence in ability to quit
• Triggers for tobacco use
• Routines/situations associated with tobacco use

Withdrawal Sx: most pass within 2–4 weeks after quitting, cravings can last longer (m-y)

• Living with another smoker
• Alcohol and socializing
• Smoking after meals
• Boredom
• Discuss methods for quitting, set a quit date, recommend tobacco use log, discuss coping strategies

Question 11

STAGE 3: Recent Quitter

Answer 11

GOAL: Remain tobacco-free for at least 6 months.

• Tailor interventions to match each patient’s needs
• Status of attempt
• Slips and relapse
• Medication adherence, plans for termination

Relapse Prevention

• Congratulate success
• Encourage continued abstinence
• Schedule additional follow-up

Question 12

STAGE 4: Former Tobacco User

Answer 12

GOAL: Remain tobacco-free for life.

• Assess status of quit attempt
• Congratulate continued success
• Inquire about and address slips and relapse
• Plans for termination of pharmacotherapy
• Review tips for relapse prevention