A Practical Guide to Help Your Patients Quit Using Tobacco

A Practical Guide to Help

Your Patients Quit Using Tobacco

Tobacco dependence is a chronic condition

driven by addiction to nicotine. No amount

of tobacco use is safe, and treatment of tobacco

use and dependence often requires multiple

interventions and long-term support. Eective

clinical interventions are available to help patients

who use tobacco to quit.

This guide provides simple steps and suggested

language that you can use to briey (3 to 5

minutes) intervene with patients who use tobacco.

These steps can be integrated into the routine

clinical workow and can be delivered by the

entire clinical care team.

Key considerations for treating tobacco dependence:

Behavioral counseling can benet all patients.

Medication can help patients quit and can be used with

most patients, though special

considerations may apply

for some individuals.

See page 3

Combining behavioral counseling and medicat

ion

is more eective than either treatment alone.

Follow-up is key to monitoring patients for treatment

adher

ence, side eects, and ecacy, along with

providing support and continued assistance.

Overview: Tobacco Cessation Brief Clinical Intervention

Ask

about current tobacco use

Provide a message of prevention

If recently quit (last 1 to 12 months), assess

challenges, condence, and need for support

YES

Advise

to quit

Assess

willingness to make a quit

attempt

Not willing at this time

` Provide a brief motivational message, set

expectations, and leave the door open to

future conversations

YES

Assist

the quit attempt

1. Brief counseling

2. Medication, if appropriate

3. Refer to additional resources

YES

Arrange

a follow-up appointment (in person or by telephone)

Clinical Intervention – Language You Can Use

Ask

Ask every patient about tobacco use

at every visit.

“Do you use tobacco products, for example cigarettes

or e-cigarettes?”

If your patient has recently quit (in the last 1 to 12

months), congratulate them and assess challenges,

condence, and need for support.

“The rst few weeks after quitting can be hard. Have

you felt the urge to use tobacco?”

“You are doing a great job. This is such an important

step to take. Is there anything I can do to

supportyou?”

If your patient has recently relapsed, provide

encouragement and support to try to quit again.

“Quitting can be hard. It can often take someone

several tries to quit successfully. Would you like to

tryagain?”

Advise + Assess

Advise your patient to quit using tobacco,

and assess their willingness to quit.

A clinician’s advice to quit is an important motivator

for patients. Using nonjudgmental language, deliver a

message that is clear, strong, and personalized.

“Quitting [smoking, chewing, etc.] is the most

important thing you can do for your health. As

someone who cares about you and your health, I’d like

to help you quit.”

“I’d like to hear your thoughts about quitting

[smoking, chewing, etc.].”

“Would you be willing to quit in the next 30 days?”

If your patient is not ready to quit, provide a brief

motivational message, set expectations, and leave the

door open to future conversation.

“I feel strongly about tobacco use and its eect on

your health. I understand that quitting can be hard,

but I am here to support you. I will ask you about it

again the next time I see you.”

Assist

If your patient is ready to make a quit attempt, assist with counseling, medications

(if appropriate), and resources for support.

Provide and document brief tobacco cessation counseling. (1-3 minutes; 3-10 minutes)

Set a quit date within 30 days

eview past quit attempts, including counseling and

medication used

Discuss potential withdrawal symptoms and coping

strategies –

see table on page 4

Discuss potential triggers and coping strategies –

see table

on page 4

Discuss, prescribe, and document tobacco cessation medication(s) unless medically contraindicated.

Populations for which there is insucient evidence for the eectiveness of cessation medications include pregnant women (unless

with medical clearance and patient consent); adolescents; people who smoke ≤5 cigarettes a day; and people who use tobacco

products other than cigarettes, including smokeless tobacco and e-cigarettes.

Nicotine replacement therapy (NRT) – patch, gum,

lozenge, inhaler, and nasal spray

Bupr

opion

arenicline

` Medication combinations: combining long-acting NRT

(i.e., patch) with short-acting NRT (e.g., lozenge) increases

the chances of quitting compared with using a single form

of NRT

Make a referral to additional in-depth and free cessation help.

State tobacco quitline

(1-800-QUIT-NOW; 1-855-DÉJELO-YA)

obacco cessation program based in the community, clinic,

or healthcare system

Web support: CDC.gov/quit; Smokefree.gov;

becomeanex.org

ext support: Smokefree.gov/SmokefreeTXT

App support: S

mokefree.gov/tools-tips/apps/quitstart

Arrange

Arrange follow-up with patients who

are making a quit attempt.

Follow up either in person or by telephone within

a week of the patient’s quit date. A second follow-up

is recommended within the rst month.

“Before you leave today, we are going to schedule a

follow-up appointment close to your quit date. We

will check in to see how your quit attempt is going,

ask if you have any questions, and see if there are

ways we can support your quit attempt.”

“Please feel free to contact us at any point. We are

here to help and support you.”

Withdrawal Symptoms and Coping Strategies

ANXIETY AND IRRITABILITY

Exercise; even a 5-minute walk can help

Contact a friend for support

Take a few slow, deep breaths

Chew sugar-free gum

INSOMNIA OR SLEEP PROBLEMS

Avoid caeine in the late afternoon and evening

Exercise

Go to sleep and wake up on a regular,

onsist

ent schedule

RESTLESSNESS

Exercise

Focus on an existing hobby, or try something new like

cooking, dr

awing, or hiking

Clean the house, garage, basement, or attic

HUNGER

Eat plenty of fruits and vegetables

Exercise regularly

Avoid high-calorie foods and beverages

Carry sugar-free gum or toothpicks

Drink more water

Triggers and Coping Strategies

SITUATIONS

Avoid people who use tobacco, or ask them not

to use tobacco around you

Establish friendships with people who don’t

use t

obacco

Avoid smoke breaks and other social situations where

you u

se tobacco

Avoid other situations where you usually use tobacco

THINGS

Get rid of cigarettes, matches, lighters, ashtrays, and

any other objects that are cues or triggers for smoking

or using other tobacco products

Avoid alcohol (at least for the rst month) as it may

trigger a desire to smoke

Develop new ways to manage stress, such as going

for a w

alk

PLACES

Avoid places where you usually buy tobacco products

Avoid locations where you usually use tobacco

Take a dierent route to work or school

Resources for Providers

CDC’s Oce on Smoking and Health –

CDC.gov/TobaccoHCP

National Cancer Institut

e: Help Others Quit

(Smokefree.gov/help-others-quit/health-professionals)

Million Hearts (av

ailable at millionhearts.hhs.gov)

•

Tobacco Cessation Protocol

Tobacco Cessation Clinical Action Guide

Tobacco Cessation Change Package

(

Treating Tobacco Use and Dependence,

Clinical Practice Guideline: 2008 Update

available at www.ahrq.gov)

U.S. Preventive Services Task Force (USPSTF) Tobacco

Cessation R

ecommendations (available at

www.uspreventiveservicestaskforce.org)

Adapted from:

Million Hearts Protocol for Identifying and Treating Patients Who Use Tobacco

(https://millionhearts.hhs.gov/les/Tobacco-Cessation-Protocol.pdf)

New York City Department of Health and Mental Hygiene Quit Smoking Coaching Guide

(https://www1.nyc.gov/assets/doh/downloads/pdf/csi/smoke-quit-smoking-coaching-guide.pdf)