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240SECT|ON‖· WHAT TO DO WITH THE INFORMAT○N Assist the patient in stopping. For those patients who express a sincere desire to stop smoking, the clinician should help them set a specific date for the next attempt. There is evidence that patients who set a "quit date are more likely to make a serious attempt to stop than those who do not(14). This date should be in the near future(generally within 4 weeks), but not immediate, giving the patient the necessary time to prepare to stop. Patients should b encouraged to announce their"quit date "to family, friends, and coworkers Once a patient has selected a specific date to stop, information must be provided so that he or she can prepare for that date. For patients who can read, this is easily accomplished by providing them with a self-help brochure. Effcctive brochures provide the patient with necessary information about smoking cessation(e. g, symptoms and time course of withdrawal,cessation tips, reasons to quit, answers to common questions). A list of print and online patient education materials is provided later in the"Resources-Patient Education Materials"section at the end of this chapter. Patients who cannot read need to acquire this information from other sources, such as audiotapes, video materials, or counseling by a clinician or health educator. Arrange follow-up visits. When patients know that their progress will be reviewed, their chances of successfully stopping improve. This monitoring may include a letter or telephone call from the office staff just before the quit date, reinforcing the decision to stop. Most relapses occur in the first weeks after cessation. A person who comes to the office after being a nonsmoker for 1-2 weeks has a much improved chance of remaining abstinent than those without follow-up (15). For this reason, it is critical that patients be contacted during their first 2 weeks of abstinence to reinforce their decision to stop Nurses or other clinicians as well as the physician may conduct this follow-up in the office or by telephone. It should consist of an assessment of the patient's progress, troubleshooting for any problems encountered or anticipated, and discussion of the effectiveness or side effects of cessation medications Although follow-up visits are critical during the first 2 weeks after cessation, clinic staff should remain in contact with the patient and schedule a formal follow-up visit in 1-2 months. For patients who cannot return for an appointment, contact by telephone or by mail may be helpful. Many patients can benefit from the social support and information offered through quit lines, Internet discussion sites, and local support group sessions offered y the American Cancer Society, the American Lung Association, or local churches or community organizations(see page 250). While onl ma proportion of patients referred to such programs actually participate(16), these programs have the potential for large public health impact. However, for individual patients, clinicians should consider these referrals as augmenting not replacing, a clinician's care
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