‘Modern’ approach to smoking cessation may increase chances of success
PHILADELPHIA — An approach to smoking cessation that treats nicotine addiction as a medical condition that must be controlled is usually more effective than other smoking cessation methods, a speaker at the American College of Physicians Internal Medicine meeting said.
Frank T. Leone, MD, MS, director of comprehensive smoking treatment programs and professor of medicine at the Hospital of the University of Pennsylvania told attendees and Healio Primary Care Today the specifics of his approach are “not deeply understood” among the medical community.
“The reality is that in school, we didn’t get a lot of good solid training in medical school on how to deal with the problem of nicotine addiction, so a lot of clinicians work from the perspective that patients will stop smoking if they know how smoking can harm them. But this ‘old-school’ technique only addresses the goal and consequently, many clinicians fill their entire careers frustrated that their patients did not stop smoking,” he said.
The knowledge gap aside, the framework for implementing his approach already exists among many clinicians in other ways, Leone said.
“It is traditional Chronic Disease Management 101. It is exactly what you do in every other part of your job. There is nothing special about getting people to stop smoking. It builds on exactly the same skill set you’ve been fine-tuning over your career,” he said.
“Stop thinking of it as getting patients to quit. Think of it as long-term management of a condition. Treat the underlying mechanisms that caused the smoking in the first place,” Leone continued. “Think about it. When a patient comes in with wheezing caused by asthma, you don’t criticize them for having asthma, you treat what caused the wheezing. Use the same approach when treating the brain biology that caused a patient’s smoking dependence.”
This starts by evaluating a patient’s dependence characteristics, psychosocial and biological determinants of tobacco use and medication regimen, and then develop an individualized multi-step, patient-centered treatment strategy for each patient that manages their dependence, Leone said.
The discussion should also consist of patients recognizing what causes smoking and relapse; creating problem solving and coping skills when difficult situations arise; separating fact from fiction regarding nicotine replacement therapies, identifying lessons learned from past quit attempts in a “nonjudgmental and supportive way” delivering positive messages to patients and not viewing past quit attempts as a failure.
“Rather than amplify the patient’s problem, you need to reframe their problem. Let them know you understand why they smoke. If they tell you they are not ready to quit, tell them you won’t make them to do anything they don’t want to do. Tell them why you are giving them the treatments you are and what you expect them and the treatment to do,” he explained.
Leone added his approach never receives pushback from its participants.
“Patients always appreciate when they feel you understand where they are coming from and that you will work with them to solve the problem. They will be very thankful of your efforts,” he said. – by Janel Miller
Leone FT. “A modern approach to tobacco dependence.” Presented at: American College of Physicians Internal Medicine Meeting; April 11-13, 2019; Philadelphia.
Pennmedicine.org. Clinical and consultative services. https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/stop-smoking-program/resources-for-health-care-providers/clinical-and-consultative-services. Accessed April 6, 2019.
Pennmedicine.org. Interested in quitting smoking? https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/stop-smoking-program/interested-in-quitting-smoking. Accessed April 6, 2019.
Pennmedicine.org. Quit smoking comfortably. https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/stop-smoking-program/quit-smoking-comfortably. Accessed April 6, 2019.
Disclosures: Leone reports no relevant financial disclosures.