Addressing the Patient

Patients who are not motivated to stop smoking should first of all be motivated. Cardiologists and nurses involved should record the smoking behavior and motivational level (Figure 29-1)1 of their patients with a smoking-related disorder and then support motivated smokers in their attempt to stop. This should also include attention and support for the period following discharge from hospital, especially in cardiac rehabilitation programs.

Many smokers succeed without aid. Just as various factors may contribute to a some patients getting addicted more quickly to nicotine than others, so some people can stop easily than others. Some smokers can quit smoking after one single advice to stop; others will need the help of quit-smoking-groups. The best results are gained by the more intensive forms of support, for example a group course.7 For those who cannot succeed in quitting this way, medication might increase their chance of success. The treatment with medication is preferably combined with psychosocial support. The five As ("ask," "assess," "advise," "assist," "arrange") shown in Table 29-2 are a simple guideline in this aspect. In cardiac patients relapse is an important issue to address during cardiac rehabilitation. A lot of patients quit smoking during their hospital stay, but find it very hard once they are in their own environment again (Table 29-3).

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