Time to enhance "5 A's" of smoking cessation?

Although this tool is considered a key approach for physicians to use in helping patients quit smoking, experts want to make it better.

By Victoria Stagg Elliott, AMNews staff. July 25, 2005.

The Public Health Service's Tobacco Cessation Guideline is slated to begin revision before the end of the year.

The "five A's" are the guideline's basic mnemonic, which encourages physicians to ask about tobacco use, advise patients to quit, assess their willingness to do so, and assist and arrange follow up. Experts in tobacco cessation in the primary care setting are wondering now whether these prompts should be changed, whether new "A's" should be added or if some need to be deleted.

"The five A's were and still are a wonderful tool to promote discussing tobacco, and [they] have tremendous value," said Susan Swartz, MD, MPH, medical director of the Center for Tobacco Independence at Maine Medical Center in Portland. "It could probably become better. Let's move to the next generation of five A's."

The A's were last updated in the 2000 guideline when the original four listed in the 1996 version were expanded to include a reminder to assess. This addition was an attempt to clarify the need for doctors to determine how ready patients were to stop. It also reflected the increasingly collaborative nature of tobacco cessation.

"The whole relationship between patients and physicians has evolved enormously," said Michael Fiore, MD, MPH, chair of the panel that devised the guideline and director of the University of Wisconsin Medical School's Center for Tobacco Research and Intervention. "It's of critical importance to ensure that patients have full participation in the plan."