Helping Smokers Quit: A Guide for Physicians
"Even brief tobacco dependence treatment is effective and should be offered to every patient who uses tobacco."
- Public Health Service (PHS) Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update
Ask about tobacco use at every visit.
Implement a system in your clinic that ensures that tobacco-use status is obtained and recorded at every patient visit.
Blood Pressure: ______________________________
Pulse: ____________ Weight: __________________
Respiratory Rate: ____________________________
Tobacco Use: Current Former Never (circle one)
Advise all tobacco users to quit.
Use clear, strong, and personalized language. For example:
"Quitting tobacco is the most important thing you can do to protect your health."
Assess readiness to quit.
Ask every tobacco user if he/she is willing to quit at this time.
- If willing to quit, provide resources and assistance (go to Assist section below).
- If unwilling to quit at this time, help motivate the patient:
- Identify reasons to quit in a supportive manner.
- Build patient's confidence about quitting.
Assist tobacco users with a quit plan.
Assist the smoker to:
- Set a quit date, ideally within 2 weeks.
- Remove tobacco products from their environment.
- Get support from family, friends, and coworkers.
- Review past quit attempts—what helped, what led to relapse.
- Anticipate challenges, particularly during the critical first few weeks, including nicotine withdrawal.
- Identify reasons for quitting and benefits of quitting.
Give advice on successful quitting:
- Total abstinence is essential—not even a single puff.
- Drinking alcohol is strongly associated with relapse.
- Allowing others to smoke in the household hinders successful quitting.
Encourage use of medication:
- Recommend use of over-the-counter nicotine patch, gum, or lozenge; or give prescription for varenicline, bupropion SR, nicotine inhaler, or nasal spray, unless contraindicated.
Go to http://www.ahrq.gov/clinic/tobacco/medsmoktab.htm to view Suggestions for the Clinical Use of Medications for Tobacco Dependence Treatment.” Refer to Attachment G for the CKHS prescription order set.
- Recommend toll free 1-800-QUIT NOW (784-8669), the national access number to State-based quitline services.
Refer to Web sites for free materials:
Arrange follow-up visits.
Schedule follow-up visits to review progress toward quitting.
If a relapse occurs, encourage repeat quit attempt.
For more information on prescribing, precautions, and side effects, go to the Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update, www.ahrq.gov/path/tobacco.htm.
U.S. Department of Health and Human Services
Public Health Service
Current as of May 2008
Helping Smokers Quit: A Guide for Clinicians. Revised May 2008. Agency for Healthcare Research and Quality. Rockville, MD. http://www.ahrq.gov/clinic/tobacco/clinhlpsmksqt.htm