Volume 1 Guidelines Smoking Cessation

SMOKING CESSATION

Brief individual counselling (1 - 3 minutes)

In order to succeed in quitting, the smoker must desire to stop, and must be able to deal with nicotine and with the smoking habit dependency.

Ask about and record every patient’s smoking habits including amount smoked and duration of the habit. A specific smoke card is of value.

At every further visit ask about and record current smoking pattern.

Ask about the desire to quit smoking. Concentrate efforts on the majority of patients who wish to do so.

Spell out the hazards of continued smoking and emphasise the health advantages of quitting to enhance motivation:

provide appropriate literature

the doctor should be specific, supporting and encouraging; previous failures should be discounted

Give explicit advice to quit.

If practicable, the practice nurse should phone the patient after the agreed quitting date, to reinforce the advice and support. Repeat at intervals for a few weeks.

Extended counselling

For recalcitrant smokers; the trained nurse can provide more extensive counselling.

Nicotine replacement

This is of value in the motivated patient, but must be accompanied by the counselling programme.

Transdermal delivery of nicotine from skin patches is promising; nicotine chewing gum has been widely used.

Nicotine should be used with great caution in patients with cardiovascular disease.

Modifying the environment

Quitters should identify and where possible avoid situations that trigger smoking.

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