More active clinician interventions may help smokers quit

Having a clinician offer assistance with smoking cessation was associated with higher quit rates among patients being screened for lung cancer, a study found.

Researchers evaluated the “5As” approach—ask, advise, assess, assist (by talking about quitting, recommending medications, or recommending counseling), and arrange follow-up—after lung screening conducted as part of the National Lung Screening Trial. They conducted a matched case-control study of 1,668 people trying to stop smoking and 1,668 matched controls. Results were published June 15 by JAMA Internal Medicine.

Deliveries of ask (adjusted odds ratio [OR], 1.10; 95% CI, 0.93 to 1.30), advise (adjusted OR, 0.99; 95% CI, 0.84 to 1.17), and assess (adjusted OR, 1.14; 95% CI, 0.98 to 1.32) were not significantly associated with quitting. However, assist was associated with an increase in the odds of quitting (adjusted OR, 1.40; 95% CI, 1.21 to 1.63), as was arrange (adjusted OR, 1.46; 95% CI, 1.19 to 1.79).

The researchers noted that their study matches previous trials in concluding that the intensity of treatment, in terms of number and length of sessions, is associated with quitting success; more intensive treatments result in greater rates of abstinence.

“Albeit challenging for busy clinicians and practices to incorporate into care, the potential gains of delivery of the 5As for patient health outcomes, as well as patient satisfaction with care, are enormous,” the authors wrote. “Smokers may experience stigma in the current social context of tobacco denormalization, and a practitioner who does not extend beyond ask, advise, and assess may be perceived as simply evaluative or may even evoke feelings of discomfort or helplessness from a patient. Assist and arrange may have a more positive connotation with patients because the clinicians are aligning themselves with patients and helping them to take action by providing support and links to resources that will help them quit. The effect of provider support, through assist and arrange, could be a collaborative and constructive experience for them.”

An invited commentary noted that ask, advise, and assess are still required steps in helping tobacco users try to quit.

“Despite continued promotional efforts by the tobacco industry, the silver lining for cessation efforts is that most smokers want to quit; national surveys consistently reveal that 70% of smokers want to quit and 50% of smokers have had a quit attempt in the past year,” the commentary said. “We need to ensure that we are offering tobacco cessation assistance, whether counseling or medication prescription or referral to a tobacco cessation resource, to every tobacco user every time that user encounters the health care system.”