Canadian smoking cessation guideline summary statements
| Summary statements | GRADE |
| Counselling and psychosocial approaches | |
| 1. ASK: tobacco use status should be updated, for all patients/clients, by all healthcare providers on a regular basis. | 1A |
| 2. ADVISE: healthcare providers should clearly advise patients/clients to quit. | 1C |
| 3. ASSESS: healthcare providers should assess the willingness of patients/clients to begin treatment to achieve abstinence (quitting). | 1C |
| 4. ASSIST: every tobacco user who expresses the willingness to begin treatment to quit should be offered assistance. | 1A |
| a) Minimal interventions, of 1–3 min, are effective and should be offered to every tobacco user. However, there is a strong dose-response relationship between the session length and successful treatment, and so intensive interventions should be used whenever possible. | 1A |
| b) Counselling by a variety or combination of delivery formats (self-help, individual, group, helpline, web-based) is effective and should be used to assist patients/clients who express a willingness to quit. | 1A |
| c) Because multiple counselling sessions increase the chances of prolonged abstinence, healthcare providers should provide four or more counselling sessions where possible. | 1A |
| d) Combining counselling and smoking cessation medication is more effective than either alone, therefore both should be provided to patients/clients trying to stop smoking where feasible. | 1A |
| e) Motivational interviewing is encouraged to support patients/clients willingness to engage in treatment now and in the future. | 1B |
| f) Two types of counselling and behavioural therapies yield significantly higher abstinence rates and should be included in smoking cessation treatment: 1) providing practical counselling on problem solving skills or skill training and 2) providing support as a part of treatment. | 1B |
| 5. ARRANGE: healthcare providers: | |
| a) should conduct regular follow-up to assess response, provide support and modify treatment as necessary. | 1C |
| b) are encouraged to refer patients/clients to relevant resources as part of the provision of treatment, where appropriate. | 1A |
| Pregnant and breastfeeding women | |
| 1. Smoking cessation should be encouraged for all pregnant, breastfeeding and postpartum women. | 1A |
| 2. During pregnancy and breastfeeding, counselling is recommended as first-line treatment for smoking cessation. | 1A |
| 3. If counselling is found ineffective, intermittent dosing nicotine replacement therapies (such as lozenges, gum) are preferred over continuous dosing of the patch after a risk-benefit analysis. | 1C |
| 4. Partners, friends and family members should also be offered smoking cessation interventions. | 2B |
| 5. A smoke-free home environment should be encouraged for pregnant and breastfeeding women to avoid exposure to second-hand smoke. | 1B |
| Youth (children and adolescents) | |
| 1. Healthcare providers who work with youth (children and adolescents) should obtain information about tobacco use (cigarettes, cigarillos, waterpipe, etc) on a regular basis. | 1A |
| 2. Healthcare providers are encouraged to provide counselling that supports abstinence from tobacco and/or cessation to youth (children and adolescents) that use tobacco. | 2C |
| 3. Healthcare providers in paediatric healthcare settings should counsel parents/guardians about the potential harmful effects of second-hand smoke on the health of their children. | 2C45 |
| Aboriginal peoples* | |
| 1. Tobacco misuse† status should be updated for all Aboriginal peoples by all healthcare providers on a regular basis. | 1A |
| 2. All healthcare providers should offer assistance to Aboriginal peoples who misuse tobacco with specific emphasis on culturally appropriate methods. | 1C |
| 3. All healthcare providers should be familiar with available cessation support services for Aboriginal peoples. | 1C |
| 4. All individuals working with Aboriginal peoples should seek appropriate training in providing evidence-based smoking cessation support. | 1C |
| Hospital-based populations | |
| 1. All patients should be made aware of hospital smoke-free policies. | 1C |
| 2. All elective patients who smoke should be directed to resources to assist them to quit smoking prior to hospital admission or surgery, where possible. | 1B |
| 3. All hospitals should have systems in place to: | |
| a) identify all smokers; | 1A |
| b) manage nicotine withdrawal during hospitalisation; | 1C |
| c) promote attempts towards long-term cessation; | 1A |
| d) provide patients with follow-up support post-hospitalisation. | 1A |
| 4. Pharmacotherapy should be considered: | |
| a) to assist patients to manage nicotine withdrawal in hospital; | 1C |
| b) for use in-hospital and posthospitalisation to promote long-term cessation. | 1B |
| Mental health and/or other addiction(s) | |
| 1. Healthcare providers should screen persons with mental illness and/or addictions for tobacco use. | 1A |
| 2. Healthcare providers should offer counselling and pharmacotherapy treatment to persons who smoke and have a mental illness and/or addiction to other substances. | 1A |
| 3. While reducing smoking or abstaining (quitting), healthcare providers should monitor the patients’/clients’ psychiatric condition(s) (mental health status and/or other addiction(s)). Medication dosage should be monitored and adjusted as necessary. | 1A |
*Aboriginal peoples is used as an inclusive term, which includes First Nations (both on and off reserve), Inuit and Métis. This is not meant to take away from the diversity that exists among Aboriginal peoples.
†Tobacco misuse does not refer to tobacco use for traditional/ceremonial purposes.