Five A’s of Counseling Patients

A Is for Opportunity

Well, not exactly.

But A is for Ask, Assess, Advise, Assist, and Arrange, the quintessential Five A’s of counseling patients to stop using tobacco. Nurses, doctors, dentists, physician’s assistants, and other healthcare providers and educators alike have an opportunity to promote smoking cessation because they have access to smokers who come to them for both routine and preventive care as well as specific guidance on health issues.

The Five A’s - Ask, Advise, Assist, Arrange Quitting smoking and chewing tobacco is a very difficult decision and process. Nicotine addiction is a bully, and its hold on smokers is powerful. So much so that patients may be unable to imagine their lives without cigarettes or smokeless tobacco. Primary healthcare visits represent important opportunities to encourage clients to quit smoking and chewing tobacco. Most smokers and smokeless tobacco users see their primary care doctor or dentist at least once each year, and many consider their family doctor as a key influence and source of advice about smoking.^2,3

The conversation that you do not have with a tobacco user who sits across from you at a checkup or other visit is an opportunity lost. If you have the tools and resources at your fingertips, you’re more likely to use them at each and every visit. So we are providing them here.

People need ample support and encouragement when they quit using tobacco, and healthcare providers are uniquely qualified to offer that service. The Five A’s are easy to use and remember.

Ask each patient about his or her tobacco use status at every visit and record the patient’s response.

Advise clear, nonjudgmental, and personalized suggestions for quitting. Tell patients that you understand quitting is difficult and challenging, but it can also be the most important thing they can do for their own health and for their families.

Assess each patient’s readiness and interest in quitting. The patient’s response to your questions about his/her willingness and readiness to quit will affect the next step in the process. If he or she is willing to quit, you’ll offer resources and assistance (next). If not, you’ll help the patient determine the barriers to cessation.

Assist each patient with a specific cessation plan. This will include materials, resources, pharmaceuticals, or referrals. Patients should be encouraged to pick a quit date and given support and feedback.

Arrange followup visits. If patients relapse, let them know you and your staff members will be there to help them dust off and start over again. Help them keep in mind that quitting takes practice, and often is not achieved after the first attempt.

Gone are the days when counseling patients to stop smoking and chewing tobacco was a matter of handing them some generic reading materials or offering the nicotine patch. It is a process that takes patience, time, and follow-through. Just as you are a resource to your patients, offering insight, assistance, and guidance, this Web site is designed to be a resource for you.

Please check out these links for free and easy-to-use checklists, guides, and other handy material that can be a part of your regular tobacco cessation counseling efforts. Even if you only have minutes with each patient, intervention and progress is possible! Be a part of one of the U.S. Military’s most critical campaigns: Quit Tobacco—Make Everyone Proud.

A is for Opportunity after all.

Resources

References

International Primary Care Respiratory Group (IPCRG) Guidelines
Richmond R, Kehoe L, Heather N, Wodak A, Webster I. General Practitioners' Promotion of Healthy Life Styles: What Patients Think. Aust NZ J Pub Health 1996;20:195-200.
Duaso M, Cheung P. Health Promotion and Lifestyle Advice in General Practice: What do Patients Think? J Adv Nurs 2002;39:472-9.