Smoking Cessation

Question 1

methods of assessing readiness to quit smoking - the 5 A’s

Answer 1

1. ask
2. advise
3. assess
4. assist
5. arrange

Question 2

5 A’s of quitting smoking: 1) ASK

Answer 2

*identify use
*identify forms (dip, chew, cigarettes, cigars, pipe, filter use, e-cigarettes, vapes)
*inquire about both current and past
*understand smoking patterns
*document total pack-year

Question 3

5 A’s of quitting smoking: 2) ADVISE

Answer 3

*urge to quit
*advice should be: clear, strong, and personalized
*active listening: non-judgmental, expect ambivalence

Question 4

5 A’s of quitting smoking: 3) ASSESS

Answer 4

*use scale of 1-10 for readiness
*determine stage of readiness:
-pre-contemplative
-contemplative
-preparation
-action
-maintenance

Question 5

5 A’s of quitting smoking: 4) ASSIST

Answer 5

*former smokers (action or maintenance stage) - provide encouragement, identify challenges
*current uses with HIGH readiness (preparation or action) - NRT, counseling
*current users with LOW readiness (pre-contemplative or contemplative) - personalize feedback, individual perceived pros and cons, 5 R’s of quitting

Question 6

5 A’s of quitting smoking: 5) ARRANGE

Answer 6

*arrange follow up
*most effective within weeks of cessation
*in person or call
*during interaction:
-identify barriers and discuss methods to overcome
-repeat 5 A’s and 5 R’s
-encourage
-congratulate

Question 7

stages of readiness to quit smoking: 1) pre-contemplation

Answer 7

*current smokers NOT planning on quitting within the next 6 months

Question 8

stages of readiness to quit smoking: 2) contemplation

Answer 8

*current smokers considering quitting within the next 6 months and have not made an attempt in the last year

Question 9

stages of readiness to quit smoking: 3) preparation

Answer 9

*current smokers who have made quit attempts in the last year and are planning to quit within the next 30 days

Question 10

stages of readiness to quit smoking: 4) action

Answer 10

*individuals who are not currently smoking and stopped within the past 6 months (recently quit)

Question 11

stages of readiness to quit smoking: 5) maintenance

Answer 11

*individuals who are not currently smoking and stopped smoking for longer than 6 months but less than 5 years (former smokers)

Question 12

5 R’s of quitting smoking

Answer 12

*relevance: why quitting is relevant to patient
*risk: verbalize negative outcomes
*rewards: identify benefits of quitting
*roadblocks: identify obstacles, including past attempts
*repetition: use the 5 A’s at every visit

Question 13

non-pharmacologic treatment for smoking cessation

Answer 13

*may help with addiction behavior
1. cognitive-behavioral therapy - action-oriented psychotherapy assumes faulty behavior
2. mindfulness-based addiction treatment - training skills to respond to now
3. group-based session - therapeutic changes through interaction with other patients and is professional lead
*nicotine addiction is a relapsing disease

Question 14

pharmacologic management for smoking cessation

Answer 14

*target dependency:
-nicotine replacement therapy
-bupropion
-varenicline
*no great pharmacologic therapy for addiction