Cessation for Adult Patients

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The 5As Assist

Help the patient quit

1. Every physician should become comfortable and knowledgeable in an approach to aid patients with smoking cessation. She/He should help those ready to quit with brief advice and pharmacologic therapy.

Assist those ready to make a quit attempt by:

1. Quit date abstinence is a strong predictor of long-term success. The quit date should be soon; ideally within 2 weeks in order to give the patient time to prepare to stop. Advise against stopping at high-stress times; suggest instead a significant date (i.e. the patient's or spouse's birthday or the first day of the month). In order to ensure a successful quit date, advise and assist the patient in preparing: 

Inform family, friends, and co-workers of quitting and request understanding and support.

1. Remove cigarettes from the environment. Prior to quitting, avoid smoking in places where a lot of time is spent (i.e. home, car).
2. Review previous quit attempts. "What helped you?" "What led to relapse?"
3. Anticipate challenges to planned quit attempt, particularly during the critical first few weeks. These include NICOTINE WITHDRAWAL SYMPTOMS.
4. Consider signing a STOP-SMOKING CONTRACT with the patient, acknowledging the patient's decision to stop smoking and noting the quit date.

Giving key advice on successful quitting.

1. Abstinence--total abstinence is essential.
2. Alcohol--Inform the patient that drinking alcohol is highly associated with relapse. Those who stop smoking should review their alcohol use and consider limiting/abstaining from alcohol during the quit process.
3. Other smokers in the household--The presence of other smokers in the household, particularly a spouse, is associated with lower success rates. If another smoker lives in the home, urge the patient to quit with the other smoker and/or develop specific plans to stay quit in a household where others still smoke.
4. Encourage PHARMACOLOGIC THERAPY for all smokers without contradictions.
5. Consider nicotine replacement especially for highly addicted patients (those who smoke one pack a day or more or who smoke their first cigarette within 30 minutes of waking).
6. Click HERE  for information on Pharmacotherapy options and patient handouts.
7. Click HERE for a Patient Handout in PDF format.

Providing self-help materials and information on community programs.

1. The information should be culturally/racially/educationally/age appropriate for the patient
2. It should be readily available in every clinic office.
3. The smoking cessation coordinator and/or the physician should review the self-help material to be prepared to answer patient questions about it.

Refering to more intensified counseling as appropriate.

1. Giving congratulations, encouragement, and a statement of concern that he/she remain abstinent. Assure the patient that a slip is not a disaster and encourage the patient to keep trying.

If the patient is not willing to quit now:

1. Providing motivating literature (or call 1-800-4-CANCER for NCI's Why Do You Smoke? pamphlet)
2. Asking again at the next visit.