• University of Michigan Health System. Smoking cessation. Ann Arbor (MI): University of Michigan Health System; 2006 Aug. 12 p. [1 reference]

This is the current release of the guideline.

This guideline updates a previous version: Smoking cessation. Guidelines for clinical care. Ann Arbor (MI): University of Michigan Health System; 2001 Feb. 9 p.

Note from the National Guideline Clearinghouse (NGC): The following key points summarize the content of the guideline. Refer to the full text for additional information, including detailed information on dosing, duration, and instructions for nicotine replacement therapies, bupropion, and varenicline and cost of drugs, counseling and motivational interventions, and considerations for special populations (i.e., pregnant and breastfeeding patients, racial and ethnic minorities, patients with psychiatric co-factors, non-cigarette tobacco users, gender concerns, older smokers, and hospitalized smokers).

The levels of evidence [A-D] are defined at the end of the Major Recommendations.

• ASK all patients about smoking status and assess smoker's readiness to quit. Smoking status should be documented in the medical record.
• ADVISE all smokers to seriously consider making a quit attempt using a clear and personalized message. Advice as brief as 3 minutes is effective [A].
• ASSESS all smokers' willingness to make a quit attempt. If not yet ready to quit, offer motivational intervention using 5 "R's" – relevance, risks, rewards, roadblocks, repetition.
• REFER patients interested in quitting within 30 days to a tobacco treatment specialist or other appropriate tobacco cessation program. Alternatively, health care providers can directly provide the following treatment:

  Treatment Options

  • ASSIST those ready to make a quit attempt:
    • Set a quit date. Quit date abstinence is a strong predictor of long-term success [C].
    • Give advice on quitting and provide supplementary materials.
    • Prescribe pharmacologic therapy as appropriate. Nicotine replacement therapies, bupropion hydrochloride, and varenicline have been proven effective [A].
  • ARRANGE follow-up either with phone call or office visit.
    • Prevent relapse by congratulating successes and reinforcing reasons for quitting.
    • Assess any difficulties with pharmacologic therapy.

Definitions:

Levels of Evidence

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational trials
4. Opinion of expert panel

An algorithm is provided in the original guideline document titled, "Clinician's Actions to Help Patients Quit Smoking."

The type of supporting evidence is identified and graded for selected recommendations (see "Major Recommendations").

Conclusions were based on prospective randomized clinical trials if available, to the exclusion of other data; if randomized controlled trials were not available, observational studies were admitted to consideration. If no such data were available for a given link in the problem formulation, expert opinion was used to estimate effect size.

• University of Michigan Health System. Smoking cessation. Ann Arbor (MI): University of Michigan Health System; 2006 Aug. 12 p. [1 reference]

The guideline was adapted from the Public Health Service guideline: Treating tobacco use and dependence. A clinical practice guideline. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service; 2000 Jun. Clinical Practice Guideline.

1998 Sep (revised 2006 Aug)

University of Michigan Health System - Academic Institution

University of Michigan Health System

Smoking Cessation Guideline Team

Team Leader: John G Frohna, MD, MPH, Internal Medicine and Pediatrics

Team Members: R Van Harrison, PhD, Medical Education; David C Serlin, MD, Family Medicine; Linda A Thomas, MS LLP, UMHS Tobacco Consultation Service

Guidelines Oversight Team: Connie Standiford, MD; William E Chavey, MD; R Van Harrison, PhD

The University of Michigan Health System endorses the Guidelines of the Association of American Medical Colleges and the Standards of the Accreditation Council for Continuing Medical Education that the individuals who present educational activities disclose significant relationships with commercial companies whose products or services are discussed. Disclosure of a relationship is not intended to suggest bias in the information presented, but is made to provide readers with information that might be of potential importance to their evaluation of the information.

None of the members of the Smoking Cessation Guideline Team have relationships with commercial companies whose products are discussed in this guideline. (The members of the team are listed on the front page of the original guideline.)

This is the current release of the guideline.

This guideline updates a previous version: Smoking cessation. Guidelines for clinical care. Ann Arbor (MI): University of Michigan Health System; 2001 Feb. 9 p.

This summary was completed by ECRI on January 11, 2002. The information was verified by the guideline developer as of February 8, 2002. This summary was updated by ECRI on November 10, 2006. The updated information was verified by the guideline developer on December 12, 2006. This summary was updated by ECRI Institute on November 9, 2007, following the U.S. Food and Drug Administration advisory on Antidepressant drugs. This summary was updated by ECRI Institute on February 5, 2008, following the U.S. Food and Drug Administration advisory on Chantix (varenicline).

This NGC summary is based on the original guideline, which is copyrighted by the University of Michigan Health System (UMHS).