238SECT|○N‖· WHAT TO DO V| TH THE|NF○RMAT|ON about smoking. Another barrier preventing clinicians from trying to help patients quit smoking includes a lack of formal training in tested cessation techniques. Perhaps most important, many office practices are not organized to support the delivery of smoking cessation interventions However, the evidence is clear: advice from clinicians helps smokers quit. Even providing brief, simple advice increases the likelihood that a smoker will successfully quit and remain abstinent 12 months later(10). The methods outlined here show how best to use the limited time available to impact smoking behavior among patients METHODS Treating Tobacco Use and Dependence, which is available online in its entirety(11)and in a summary for clinicians(12), details the PhS clinical practice guidelines for promoting smoking cessation among patients Clinician Intervention The clinician intervention recommended in the phs guideline comprises five activities, each beginning with the letter"A"(often referred to as the 5 As, as discussed in Chapter 5) Ask all patients about smok Advise smokers to stop Assess if the smoker is willing to make a quit attempt Assist their efforts with self-help materials, a quit date, and possibl cessation medication Arrange follow-up This intervention plan describes a general approach to patients who smoke and can be used in almost any outpatient encounter, whether th clinician and patient have 30 seconds or 30 minutes for the discussion (13/ c Ask about smoking at every opportunity. For example, a nurse or other staff member should routinely ask patients“ Do you smoke?”or“ re you still smoking?"at each visit, usually while measuring vital signs. Once it is known that a person smokes, an identifier should be placed prominently on the patient's chart to remind the clinician and staff to discuss smoking at each visit (see Fig 9. 1).(See Chapters 21 and 22 for further information about chart alert stickers, automated prompts, and other clinician reminder systems. )Patients who have never smoked or who formerly smoked should be congratulated on their decision Advise all smokers to stop. A clear statement of advice(e. g, "As your physician, I must advise you to stop smoking now)is essential. Many patients do not recall receiving this advice from their clinician. Therefore, the statement must be