This video presents information on providing brief tobacco
cessation interventions.
The goal of this module is to illustrate
how cessation counseling, and providing practical advice
on effective strategies that increase a patient's
odds of success, can help patients understand
the risks of tobacco use.
And the benefits of quitting.
Busy, practicing physicians may not
have time for lengthy counseling sessions on tobacco cessation.
However, brief cessation advice, as short as three minutes,
has been proven to be effective in increasing
tobacco cessation.
There are several structured approaches
that have been widely used for brief cessation intervention.
One of the best known is the 5 A's model.
The A's stand for ask, advise, assess, assist, and arrange.
When using these strategies it is important to ensure that
the patient has easy access to all of the 5 A's.
Let's look at each A one by one.
The first A, ask.
It is important to routinely ask all patients
if they use tobacco.
This should be done in a friendly and approachable
manner.
For example, may I ask if you use any tobacco products?
Identify and document tobacco use
status for every patient at every visit.
The second A, advise.
If the patient indicates that they use tobacco,
advise them to quit.
You can relay information on the harms of tobacco use,
and the benefits of quitting, that have been described
in previous modules.
Your advice should be clear, strong,
and personalized to the individual patient.
This includes using appropriate language that can
be understood by the patient.
For example, "it is important that you quit tobacco use now.
And I can help you."
And, "quitting tobacco is the most important thing
you can do to protect your health."
You can personalize these messages by saying something
like, "continuing to smoke makes your asthma worse,
and quitting may dramatically improve your health."
The third A, assess.
This step will determine whether a tobacco
user is ready to quit.
For example, are you willing to quit?
You may encounter patients at different stages in the change
process.
For patients who have not had thoughts about quitting,
and are not interested in cessation,
you can use this time to raise your awareness about the health
effects of their tobacco use.
It is important to let them know that you
are happy to help if they do become interested in quitting.
For individuals who have had thoughts about quitting,
but are not yet ready to set a quit date,
you can use this time to emphasize
the benefits of quitting.
You can offer them the opportunity
to answer any questions they may have
to reduce their uncertainty, so they
will be able to set a quit date in the future.
The fourth A, assist.
For individuals who are willing to make a quit attempt,
your role is to help them do so.
This could include putting together a quit plan with them.
This plan will involve helping them to set a quit date,
asking them to tell family, friends, and coworkers
about their quit date, to gain support,
talking through any challenges they anticipate,
and asking them to remove all tobacco products
from their home and workplace.
You can also prescribe any appropriate medication,
and refer them to a cessation specialist who
has the skills, and time, to help them quit.
And finally the fifth A, arrange.
Follow -up regularly with patients
who are trying to quit to offer further assistance.
When assessing tobacco users readiness to quit,
some may be unwilling to stop using tobacco
for a variety of reasons.
Such as misinformation, concerns about the physical effects
of quitting, and prior unsuccessful attempts.
Based on your assessment, when a tobacco user appears unwilling
to make a quit attempt, a brief motivational intervention can
be used called the 5 R's.
The R's stand for relevance, risks, rewards, roadblocks,
and repetition.
Let's look at each R individually.
The first R, relevance.
Ask the patient, "how is quitting relevant to you?"
If the patient does not think it is relevant,
you may try explaining how quitting
can improve his, or her, own health,
and the health of their family.
The second R, risk.
Ask, "what do you know about the risks of tobacco use
that impact you personally?"
If the patient does not know, provide
information on the harms of tobacco use
as covered in previous modules.
The third R, reward.
Ask, "what would be the benefits of quitting that affect you
personally?"
If the patient does not know, provide information
on the benefits of quitting as covered
in the previous modules.
The fourth R, roadblocks.
Ask, "what would be difficult about quitting for you?"
Provide concrete steps to address these concerns.
You can also tell the patient that it
may take multiple quit attempts before he,
or she, successfully quits.
And finally, the fifth R. Repetition.
Repeat assessment of readiness to quit at each patient visit.
The more often a health care provider brings up the subject,
the more likely the patient will attempt to quit.
Research indicates that patients do not
mind being asked about their tobacco use,
and expect their physician to encourage them to quit.
In addition to the 5 A's, and 5 R's,
there are other brief tobacco interventions that
may require even less time.
And may be useful in your clinical setting.
You will notice that all of these interventions
deliver the 5 A's, but some of them
are delivered by other health care or public health
organizations.
All of the interventions in the clinical setting include
the ask and advise steps from the 5 A's.
Let's take a look.
The first is ask, advise, refer.
Or AAR.
In this intervention the health provider
can refer a tobacco user to a quit line, cessation
specialist, or other resource for quit plan development.
And further cessation management.
And finally, ask, brief advice, cessation support, or ABC.
In this intervention the health provider
provides cessation support for those who desire to quit.
This may be done by developing a quit plan,
or referring to a cessation specialist.
In closing, the 5 A's are a standard, and effective,
approach for brief tobacco intervention.
The readiness of the patient to quit tobacco
will affect the amount of time required for the intervention.
But even a brief intervention of a few minutes
can be effective for increased quit rates.
Furthermore, if you are not able to counsel a patient fully
due to limited time, it is important to refer
patients to cessation specialist,
or other resources in your community.
The next video ready to view will discuss your role
in tobacco control outside of the exam.