Text adapted in 2021 from Smoking Cessation in The Primary Care Addiction Toolkit (online only). A complete list of Toolkit authors, editors and contributors is available here.
Screening for Smoking: Tips
The most important element of a tobacco use screening program is a reliable system to remind you to ask all patients if they smoke. Reminders to screen can come from a computer system or from your staff, or they can appear on the patient's chart.
In addition to having a reliable screening reminder system, follow these specific practices in your screening program:
- Identify the smoking status of all patients over age 10 on every visit.
- Congratulate patients who don't smoke or who have quit.
- Tell patients who smoke that quitting would be the single most important change they could make in their health.
- Ask all patients who smoke if they are considering quitting.
- If patients are not considering quitting, ask what might be the reasons.
- If patients are considering quitting, congratulate them and ask when they might be willing to try quitting.advise them that using pharmacotherapy and receiving counselling will make them most likely to quit.
- If patients are willing to try quitting within the next month, suggest a follow-up visit to discuss it.
- If patients are willing to try to quit in the next 6 months, tell them that you can help when they need it.
The "five As" are an easy way to remember the key steps of screening for smoking cessation:
- Ask: Identify in their chart all patients who smoke.
- Advise: Find a kind but clear, forceful and personalized way of recommending that the patient quit.
- Assess: Check out the patient's readiness to quit
- Assist: Offer assistance whether the patient is ready or not.
- Arrange: Arrange for the patient to follow up with you or at a smoking cessation clinic.
Provincial regulations may allow doctors to bill for screening for smoking and for smoking cessation counselling. For example, in Ontario, the Ministry of Health and Long-Term Care has provided extra fee codes that physicians can use in addition to codes for regular visits if they complete the five As with patients.