COMMENTARY

A Brief Intervention to Help Patients Quit Smoking

Tim McAfee, MD, MPH

Disclosures

January 07, 2013

Editorial Collaboration

Medscape &

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Hello, I am Dr. Tim McAfee, Director of the Office on Smoking and Health at the Centers for Disease Control and Prevention (CDC).

I am happy to be with you today as part of the CDC Expert Commentary Series on Medscape. Today I will be talking about how to conduct a brief intervention to help patients quit smoking.

As a physician, I have treated thousands of smokers. I know from first-hand experience that by routinely taking a few brief, simple actions, doctors can help patients to quit smoking.

The good news is that most smokers say they want to quit, and more than one half try to quit each year. And smokers who succeed at quitting gain as much as 10 years of their life expectancy back.

As a doctor, you can play a critical role in helping your patients to successfully quit smoking. When you advise a patient, even briefly, to quit smoking, you significantly increase his or her chances of quitting.

Smokers cite physician advice to quit as an important motivator for trying to stop smoking. Although most physicians today ask patients whether they smoke, fewer doctors provide patients with practical help in quitting.

You may be thinking, "I just don't have time to talk to my patients about quitting." However, you can ask about tobacco use, advise the patient to quit, and refer the patient to a counselor, class, or telephone quitline in less than 1 minute.

These 3 steps -- ask, advise, and refer -- are sometimes called the "2A and R" brief tobacco intervention. In addition, some steps can be handed off to other members of your healthcare team or to community referral resources, further reducing the demand on your time.

Step 1: Ask. While collecting vital signs, a nurse or medical assistant can ask the patient whether he or she smokes or uses other forms of tobacco, and document the patient's tobacco use status in the chart or electronic health record. Most practices in the United States now do this.

Step 2: Advise. You can briefly advise the patient to quit by saying something like, "I see that you smoke. Quitting smoking is one of the most important things you can do for your health right now. Have you thought about quitting?" This advice works best when delivered in a nonjudgmental tone.

You can make the advice more compelling by personalizing it: for example, by linking it to the reason for the patient's visit.

Step 3: Refer. For patients who are interested in trying to quit, you, a nurse, or other members of your team can refer patients to your state's quitline or other community counseling resources. Quitlines are free telephone cessation services that have been found to be effective in helping smokers quit. Every state has its own quitline, and the national number 1-800-QUIT-NOW seamlessly routes callers to their state quitline. For more information on your state quitline or on quitlines in general, see www.naquitline.org.

More and more hospitals, insurers, and clinics are providing tobacco cessation counseling resources. In addition, you can discuss the use of over-the-counter or prescription smoking cessation medications, if appropriate, to help relieve withdrawal symptoms.

Of course, if you take just a few minutes to offer the patient some brief counseling before referring them to another resource, this is even better and can make a big difference.

For patients who are not interested in quitting, saying something as simple as, "I'm here to help you whenever you are ready to quit" can leave the door open for them to raise this issue in the future while letting them know that you care. You can also probe for the barriers that are preventing patients from being interested in quitting and explore what it would take to make them more interested.

In addition to dividing these steps up among members of the healthcare team, you can make specific changes to your clinic system to make addressing tobacco use easier for you. For example, adding a prompt in the electronic health record or flagging patients who smoke or use other forms of tobacco serves as a helpful reminder to address the issue. Keeping brochures or flyers in each patient room with information about resources can also make the referral process easier.

Some providers are concerned that bringing up tobacco use could upset their patients. In fact, surveys have found that smokers expect their doctor to address their smoking and are more satisfied with their care if this happens, as long as it is done empathetically.

Many providers are also concerned about lack of reimbursement for cessation treatment. The good news is that many more insurers are starting to reimburse for cessation treatment, including medications, counseling, and physician time, although this can still be challenging.

Some providers are uncomfortable raising this topic and don't know how to do so. In early 2013, the CDC is planning to conduct a second round of "Tips From Former Smokers," the national tobacco education media campaign that we first conducted in 2012. This campaign features powerful testimonials from former smokers who are living with serious smoking-related diseases.

The campaign could make it easier to bring up the topic of smoking with your patients. For example, you could open the conversation by asking patients who smoke if they have seen the ads. If patients have seen the ads, you could ask them what they thought about the ads.

If your patients haven't seen the ads, you could encourage them to visit the campaign Website, where the ads are available for viewing. You could also display posters of the ads in your reception area and in examination rooms.

In conclusion, as a provider, you can play a critical role in helping your patients quit smoking. Even brief advice can make a big difference. You don't have to do it all; you can turn to other members of your team and use referral resources that already exist in your state and community to support your efforts and reduce the demand on your time. Your advice and the support you provide, directly and through referrals, can give patients the extra motivation and support they need to quit for good.

For more information on talking to patients about tobacco, please visit the links provided on this page. Providers can also help their patients quit by getting involved in broader community efforts to reduce tobacco use and secondhand smoke exposure, including supporting comprehensive tobacco control efforts in your community.

Web Resources

American Academy of Family Physicians: Ask and Act Tobacco Cessation Program

CDC: Smoking and Tobacco Use

CDC: Tips From Former Smokers

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