Smoking kills more than 400,000 persons a year in the United States. Every office visit is an opportunity to promote smoking cessation among patients who smoke.
This Clinician’s Guide is based on the Clinical Practice Guideline on Smoking Cessation, Number 18. It was prepared by a panel of experts convened by the Agency for Health Care Policy and Research, and reflects a thorough review of evidence from clinical studies spanning 1978 to 1994.
Implement an officewide system that ensures that tobacco-use status is obtained and recorded for every patient at every office visit.
Include tobacco use in vital signs data collected. Or place tobacco-use status stickers on all patient charts or indicate smoking status using computer reminder systems.
Advise the smoker to:
Give advice on successful quitting:
Encourage use of nicotine replacement therapy (for more information on prescribing, precautions, and side effects, see the Clinical Practice Guideline):
Make culturally and educationally appropriate materials on cessation techniques readily available in your office.
If your patient prefers intensive treatment or you think such a program is appropriate, refer him or her to an intensive smoking cessation program administered by a specialist. Always followup with the patient about quitting.
If a smoker doesn’t want to quit, clinicians should ask questions at each visit that help the patient identify (1) reasons to quit and (2) barriers to quitting. Pledge to assist the patient when he or she is ready to quit.
Nicotine replacement therapy—Should be encouraged for most patients. Although the patch and gum are both effective, the patch is associated with fewer compliance problems and requires less effort to train patients in its use.
Clinician-provided social support—Should communicate caring and concern by being open to the patient’s fears and difficulties.
Skills training/problem-solving techniques—Should review previous quit successes and failures, anticipate relapse risk situations, and stress total abstinence starting on the quit day.
Actions during followup visits:
All treatment strategies apply to adolescents who smoke. Clinicians should be empathetic and nonjudgmental and should personalize the encounter to the adolescent’s individual situation. Nicotine replacement therapy may be considered in adolescents addicted to nicotine.
Discuss specific problems, such as:
Fear of weight gain is an impediment to smoking cessation. Inform smokers that many people gain weight when they stop smoking. Tell them that weight gain is a minor risk compared with the risks of continued smoking. Tell patients to tackle one problem at a time. First, be confident that they have quit smoking for good, then work on reducing weight gain. Nicotine gum may delay weight gain.
For printed copies of this guide, the complete Clinical Practice Guideline, a Quick Reference Guide for Smoking Cessation Specialists, a Consumer Version (available in English and Spanish), or a list of other AHCPR guidelines, call 800-358-9295 or write:
AHCPR Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907
These and other guidelines are available through the Internet (http://www.ahcpr.gov/guide/). Copies of this and other brochures are free through InstantFAX, which operates all day every day. Using a fax machine equipped with a touchtone telephone, dial (301) 594-2800, push 1, and then press the start button for instructions and a list of publications.
U.S. Department of Health and Human Services
Public Health Service
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 501
Rockville, MD 20852
AHCPR Publication No. 96-0693
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