Smoking cessation: tools to identify and support patients

  smoking is the leading preventable cause of death. One in every two regular smokers will die as a result of a tobacco-related ailment. Tobacco control is a top concern for public health. The Start now outlines management approaches and tools to assist clinicians in identifying smoking patients and assisting them in quitting smoking. Explanations provided by Estelle Lavie* of the Start now Good Business Practices Department.

What are the benefits of quitting smoking?

Smoking cessation lowers mortality, particularly from cardiovascular disease and lung cancer. The benefit is available regardless of the age of the patient at the time of termination. Thus, a patient who quits smoking at the age of 40 raises his life expectancy from 7 to 50 years... Smokers must therefore be identified in a systematic manner. To receive withdrawal help, all patients should be asked about their potential cigarette usage.

When a smoker is recognized, it is critical to persuade him to quit. This simple quit tip from a health professional boosts their chances of stopping smoking significantly (see "Examples of Quit Tips" tool). The motivation of the patient is then evaluated.

The medical attitude will be determined by the patient's level of ambivalence toward smoking (see tool "Recommended medical attitude based on the patient's stage of change").

It is critical to offer for regular consultations dedicated to smoking cessation management.

The foundation of assistance is emotional and psychological support. If the patient is addicted, nicotine replacement treatment (TNS) is recommended. It alleviates withdrawal symptoms, decreases the desire to smoke, and avoids relapses.

How to assess a patient’s addiction?

Addiction is described as a lack of the ability to refrain. A patient is considered dependent if one of three conditions is met:

• He relapsed after attempting to abstain.
• He continues to smoke despite the obvious health implications (infarction, COPD, cancer...) or the hazards he faces in specific conditions (surgery, pregnancy, etc.).
• He is often concerned about running out of tobacco. Testing is done to determine the degree of reliance (Fagerström).

How to assess a patient’s motivation to stop?

• The Prochaska and DiClemente models, for example, can be used to analyze motivation. It is assumed that smokers will go through five steps to quit:
• The subject has not yet contemplated stopping smoking.
• intention: he considers stopping but is unsure.
• Make the decision to quit smoking and devise a smoking cessation strategy.
• He is actively engaged in change: he has quit smoking.
• He has regained his independence from addiction, but realizes that he must remain cautious to avoid return.

What are the proposed methods to accompany smoking cessation?

A smoker is more likely to quit if he or she is accompanied by a professional: doctor, nurse, psychologist, etc. The attending physician is the main participant in ensuring that management is based on support and psychological assistance.

TNS is recommended as the first line of treatment for dependent patients.

Other tools that have been demonstrated to be effective include:

• Motivational interviewing (to encourage and support change motivation)
• Cognitive behavioral therapy (CBT) (special training required).
• Telephone assistance (Tobacco information service line: 3989)
• auto-assistance tools (www.tabac-info-service.fr).

How to avoid relapses?

Management seeks to prevent numerous relapses once the cessation has begun because addiction persists after the stop. They could be caused by an insufficient dose of TNS, anxiety-depressive illnesses, weight gain, and so on. Risk prevention strategies are established. Each event that causes the patient to smoke is examined, the "faux pas" is de-ramatized, and the patient is released of guilt while being told that relapses are a normal part of the cessation process.