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Don't Wait for Them to Ask

Elizabeth Thompson Beckley

The American Diabetes Association recommends advising all patients withdiabetes not to smoke and including smoking cessation counseling and otherforms of treatment as a routine part of diabetescare.¹

The U.S. Public Health Service says successful intervention of tobaccohabits begins with identifying tobacco users and appropriate treatments basedon the patient's willingness to quit. The five major steps to intervention arecalled the 5 A's, the gold standard for cessation treatment:

• Ask—Identify and document tobacco-use status for every patientat every visit.
  
• Advise—In a clear, strong, and personalized manner, urge everytobacco user to quit.
  
• Assess—Determine whether the tobacco user is willing toattempt to quit at this time.
  
• Assist—For the patient willing to attempt to quit, usecounseling and pharmacotherapy to help.
  
• Arrange—Schedule follow-up contact, in person or by telephone,preferably within the first week after the quitdate.
  

But according to recent research, while clinicians demonstrate significantcompliance with the first two steps—90% of smokers were asked aboutsmoking and 71% were advised to quit—stronger efforts are needed to takethe next steps.²Doctors assessed 56% of patients for their willingness to quit, 49% ofpatients received assistance interventions, and follow-up care was arrangedfor 9%.

"The strongest predictor of these cessation services was a requestfor help," conclude the researchers from Kaiser Permanente SouthernCalifornia. "Treatment was provided more often to smokers who asked forhelp and/or intended to quit."

The study surveyed more than 4,200 smokers, aged 25–75 years, whowere members of nine nonprofit health maintenance organizations participatingin the National Cancer Institute–funded Cancer Research Network.

"In contrast to widely reported concerns about smokers' resistance totobacco interventions, smokers who received treatment were more satisfied withhealth plan services," writes lead investigator Virginia P. Quinn,PhD.

A recent paper in JAMA concludes that knowing most smokers requiremultiple attempts to quit before they succeed may help counter someclinicians' pessimism about the utility of cessationtreatment.³ They mayalso be encourgaed by rigorous studies that show long-term quit rates of14–20%, even as high as 35%, and by the fact that "no otherclinical intervention can offer such a large potential benefit."

References

1. American Diabetes Association: Standards of medical care indiabetes (Position Statement). Diabetes Care 28 (Suppl. 1): S4–S36, 2005.[Free Full Text]

2. Quinn VP, Stevens VJ, Hollis JF, et al.: Tobacco-cessation servicesand patient satisfaction in nine nonprofit HMOs. Am J PrevMed 29:77–84, 2005.[Medline]

3. Schroeder SA: What to do with a patient who smokes.JAMA 294:482–487, 2005.[Abstract/Free Full Text]

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Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Beckley, E. T. Search for Related Content PubMed Articles by Beckley, E. T. Social Bookmarking                What's this?