The First Method: The 5A's - For Those Ready to Quit

Counseling Your Patients on Smoking Cessation

Evidence demonstrates that even brief clinical
interventions can significantly increase the rates at
which patients quit smoking


When counseling your patients about smoking, the Agency for Healthcare Research recommends a brief smoking cessation intervention known as the "5 A’s": Ask, Advise, Assess, Assist, and Arrange. 

This entire counseling process takes less than three minutes.[i]

Clinical judgment is most important when counseling patients.  The following scripts are examples to address smoking cessation while using the 5A’s.  Please add your own scripts and discuss your counseling methods on our monthly ACOG conference calls.  Other office sites will be particularly interested in your “teachable moments” and verbal cues.


ASK
Ensure that tobacco-use status is obtained and recorded at every patient visit.  When possible, ask open-ended questions so the patient will have an opportunity to elaborate. 

Many of your “Ask” questions will have already been answered by patients on the Smoking Survey, however, the scripts below will help you initiate the conversation. “I see from your Smoking Survey that…”

  • “Have you ever smoked?”
  • “How often do you smoke?”
  • “When is the last time you smoked?”
  • “How many cigarettes did you smoke yesterday/last week/last month?”
  • “Why do you think it would be a good idea to quit?”
  • “Do you dip or use snuff?”


ADVISE
Advise your patient to quit smoking.  Use clear, strong and personalized language to get your point across.

  • “Quitting is the single most important thing you can do to protect your health as well as your family.”
  •  “The effects of your secondhand smoke are harmful to your family.   I suggest you quit not only for them but for yourself.”
  • “Smokers who quit save an average of $120 a month.”


ASSESS
Ask every patient if she is willing to quit at this time.  If she is willing to quit, offer praise and provide resources and assistance.

If unwilling to quit, help motivate the patient by using the 5R’s (on Page 13).

If they have tried to quit in the past, get more information.

  • “So you’ve tried to quit.  What do you think triggered you to start smoking again?”


ASSIST
Assist your patient with a quit plan.

Give advice on successful quitting.

  • “It is best if you refrain from drinking alcohol at the beginning of your effort to quit smoking as alcohol is strongly associated with relapse.”
  •  “I suggest you ask others not to smoke in the house while you are trying to quit as it may hinder your success.”

Provide resources for your patient.

  • “If you feel you need more support to help you quit, here is a list of support groups in our area.”
  • “Let me give you some education materials on the benefits of not smoking that will help make quitting easier.”
  • “There are some great resources on the internet that can help you with quitting.  Here is a list of websites I recommend.”
  • “For further assistance with quitting, call the New York State Quitline at 1-866-NY-QUITS.  The Quitline will connect you with local resources that can help you quit.”
  • “Go to nysmokefree.com for more information about quitting as well as additional resources from the New York State Department of Health.”

Assist your patient to quit by setting a quit date, ideally within 2 weeks of the visit.

  • “Together, we will set a date that will be scheduled as your last day of smoking.  How about next Monday?”
  • “When do you think would be a good time for you to quit?”

Have the patient arrange support from family, friends and co-workers.

  • “Do you have friends or family you can call if you get an urge?”
  • “If you have the urge to smoke, you can call the NY State Quitline at 1-866-NY-QUITS.  There are counselors on call 24/7 to help you.”


ARRANGE
Schedule follow-up visits/phone calls to review patient progress toward quitting.


 

 


 

 

[i] Warner, Brian.  Helping surgical patients quit smoking: why, when and how. Anesth Analg, 2005; 101: 481-7.