Smoking Cessation – CAN-ADAPTT Guideline 2012

Motivational Tasks Associated with Patient Stages of Change

  1. Precontemplation – Not considering the possibility of change
    • Raise doubt.Help patient understand the benefits of the unhealthy behaviour, while at the same time highlighting the costs
  2. Contemplation – Seriously thinking about change, but not ready to take action. The individual considers change and rejects it
    • Tip the balance in favor of change: Strengthen patient self-efficacy to change by drawing upon past successes
  3. Preparation – Getting ready to change
    • Help the patient identify small, realistic behavioural steps towards change
  4. Action – Actively engaged in a new healthier behaviour
    • Support new behaviours, empathize difficulty of change behaviour
  5. Maintenance – Maintain new behaviour for several months
    • Help the individual use new skills to prevent relapse
  6. Relapse – Return to old pattern of unhealthy behaviour
    • Help the patient avoid discouragement and demoralization

Couselling and psychosocial Approaches

The 5A’s tool – for pt willing to Quit

  • ASK: Tobacco use status updated for all pt on a regular Basis
    • “Have you used any form of tobacco in the past 6mo?”
    • Smoked: cigarettes, cigarillos, cigars, blunts, pipe, shisha, hookah, electronic cigarette
    • Smokeless: chewing tobacco, dipping tobacco, dissolvable tobacco, snus, snuff
    • Identify prev quit attempts and results
  • Advice: Clearly advise pt to quit.
    • make pt aware of withdrawal symptoms:
      1. low mood, insomnia, irritability, anxiety
      2. difficulty concentrating, restlessness
      3. decreased HR, increased appetite
  • Assess: Assess the willingness of pt to begin Tx to achieve abstinence
  • Assist: Offer assistance to every pt who expresses the willingness to begin Tx to quit
    1. Intensive interventions: dose-response relationship between the session length & successful Tx
    2. Provide resources / counselling: self-help, individual, group, helpline, web-based, motivational interviewing
    3. ≥ 4 counselling sessions >10min each with 6-12 months f/u yield better result 
    4. Combination counselling and smoking cessation medication is more effective than either alone.
    5. Provide practical counselling on problem solving skills + provide support as a part of Tx
  • Arrange:
    • Regular f/u to assess response, provide support, and modify Tx
    • Refer pt to relevant resources

Aboriginal People

  • Tobacco misuse status updated on a regular basis
  • Offer assistance to pt who misuse tobacco with specific emphasis on culturally appropriate methods
  • Familiar w/ available cessation support services
  • Seek appropriate training in providing evidence-based smoking cessation support

Hospital-Based population

  • All pt should be made aware of hospital smoke-free policies
  • Elective pt should be directed to resources to assist them to quit prior to admission or surgery
  • All hospital should have systems in place to
    • identify all smoker
    • Rx nicotine withdrawal during hospitalization
    • promote attempts toward long-term cessation
    • Provide pt with f/u support post-hospitalization
  • Pharmacotherapy
    • to assist pt to manage nicotine withdrawal in hospital
    • for use in-hospital & post-hospitalization to promote long term cessation

Mental health +/- other addicitons

  • Screen pt with mental illness / additions for tobacco use
  • Offer counselling & pharmacotherapy Tx to persons who smoke & have a mental illness / addiction to other substances
  • While reducing smoking or quiting, monitor pt’s psychiatric condition(s): mental health status, other addicitons. Medication dosage be monitored and adjusted as necessary

Pregnant and Breastfeeding women

  • Smoking cessation encourage for all pregnant, breastfeeding, postpartum women
  • Counselling is 1st line Tx in pregnancy and breastfeeding
  • If counselling ineffective, intermittent dosing nicotine replacement (lozenges, gum) are preferred over continuous dosing of the patch (↑risk)
  • Partners, friends, family should also be offered smoking cessation interventions.
  • A smoke-free home environment encouraged for pregnant and breastfeeding women to avoid exposure to second-hand smoke


  • Obtain info about tobacco use – cigarettes, cigarillos, waterpipe, etc on a regular basis
  • Couselling that supports abstinence from tobacco / cessation
  • Counsel parents about the potential harmful effects of 2nd-hand smoke on the health of their children


Posted in 85 Smoking Cessation, 99 Priority Topics, FM 99 priority topics, Resp

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