What About the 5 A’s?
In this Roadmap, we do not focus on the 5 A’s (Ask, Advise, Assess, Assist, Arrange) or streamlined alternatives (Bentz et al., 2006; Vidrine et al., 2013) because we want to offer flexible guidance and tools to support two key functions of effective tobacco treatment programs—screening and treatment.
Screening activities should include both Asking about tobacco use, and Advising patients that tobacco exposure affects cancer care, and that help is available.
Treatment activities should include clear Advice to quit, offers of Assistance (and Assessing which forms of treatment may be right for the patient), and Arranging referral or follow-up contacts.
All of these models stress the importance of giving clear and non-judgmental advice regarding the benefit of tobacco cessation. Examples of this include the following (adapted from p. 4 the Kansas Tobacco Guideline for Behavioral Health Care, 2018):
- I want to work with you to reduce your tobacco use so your cancer treatment works better.
- Quitting tobacco is one of the most important things you can do to help your cancer treatment. I strongly encourage you to get support in quitting tobacco, and we can help you.
- Quitting can improve your cancer care and may help your family too. I can help you change your tobacco use.
It is no longer recommended that treatment be contingent on patient readiness to quit (Barua et al., 2018; National Comprehensive Cancer Network, 2022). In opt-out approaches, for example, delivering tobacco treatment is the default and is not contingent on patients expressing willingness to use tobacco treatment (Richter et al., 2023).
In addition, best practices in tobacco treatment now incorporate follow-up regarding patient progress and treatment needs as key parts of tobacco treatment. Arranging follow-up should be an integral part of Assisting patients who use tobacco in quitting.