Use 'Five A's' in Smoking Cessation Counseling

By Boschert, Sherry | Clinical Psychiatry News, January 2004 | Go to article overview

Use 'Five A's' in Smoking Cessation Counseling


Boschert, Sherry, Clinical Psychiatry News


SEATTLE -- Follow the "five A's" to help patients stop smoking: Ask, Advise, Assess, Assist, and Arrange, Dr. Richard C. Pasternak said.

"Nurses are more familiar with these than are physicians," he noted at a meeting on modifying coronary risk factors sponsored by the American College of Cardiology Foundation.

Ask about smoking at every patient visit. Advise every smoker to stop. Assess the patient's readiness to quit. Assist patients, whether they're ready to quit or not. Arrange a follow-up visit, and discuss the subject of smoking at every subsequent visit.

Routine advice from physicians to stop smoking helps patients quit, studies show, but brief counseling employing the five A's is more effective, said Dr. Pasternak, director of preventive cardiology and cardiac rehabilitation at Massachusetts General Hospital, Boston.

1. Ask. You or your staff routinely should ask patients, "Do you smoke?"

2. Advise. Be firm and clear and keep a positive tone when you tell patients who smoke, "Quitting smoking now is the most important action you can take."

Tailor the reasons to the patient's clinical situation.

3. Assess. Some patients may not be ready to even contemplate quitting, and may tell you, "I like to smoke," he noted. Others who have contemplated quitting may say. "I want to quit, but ..." Patients who are prepared to stop smoking will say so: "I'm ready to quit." Tailor your assistance strategies to the patient's level of readiness to quit.

About 70% of smokers say they want to quit, and 30% try to quit each year. Only 30%-40% succeed initially, but half of all Americans who ever smoked have quit, he noted.

Project confidence that the patient can quit.

"If you don't really believe that the patient is going to quit smoking, their antennae will pick that up" and make them less likely to succeed, Dr. …

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