ArticleAmerican journal of preventive medicine2009
Development of an instrument to document the 5A's for smoking cessation.
Article in American journal of preventive medicine, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Systematic review of observational coding systems to assess patient-healthcare professional interactions.Patient education and counseling · 2025Pooled it
- A Systematic Literature Review of Self-Reported Smoking Cessation Counseling by Primary Care Physicians.PloS one · 2016Pooled it
- Article
- Evaluating expert opinions on using a virtual patient app based on artificial intelligence for teaching brief smoking cessation advice to medical students: a cross-sectional study.BMC medical education · 2026Article
- Determinants of smoking cessation program completion and continued tobacco use in a referral program in West Virginia: An EHR data analysis from 2018-2023.Tobacco prevention & cessation · 2026Article
- Understanding barriers and identifying solutions for smoking cessation in primary care: survey results informed by an integrated knowledge translation approach in British Columbia, Canada.BMJ open quality · 2025Article
- AI-Enabled Personalized Smoking Cessation Intervention With the Aipaca Chatbot: Mixed Methods Feasibility Study.JMIR formative research · 2025Observational
- Tobacco treatment billing and tobacco use disorder diagnosis in healthcare settings in the United States: an analysis of South Carolina medicaid claims.Substance abuse treatment, prevention, and policy · 2025Article
- The 10-year anniversary of the dissemination and implementation models in health interactive webtool: History, refinement, use, and guidance.Journal of clinical and translational science · 2025Article
- Barriers to implementation of smoking cessation support among healthcare professionals in the secondary healthcare sector: A qualitative and quantitative evaluation.Tobacco prevention & cessation · 2024Article
- Study design and protocol of a stepped wedge cluster randomized trial using a practical implementation strategy as a model for hypertension-HIV integration - the MAP-IT trial.Implementation science : IS · 2023Article
- Integration of a task strengthening strategy for hypertension management into HIV care in Nigeria: a cluster randomized controlled trial study protocol.Implementation science : IS · 2021Article
- General dental practitioners' knowledge and opinions of snoring and sleep-related breathing disorders.British dental journal · 2021Article
- Feasibility of Audio-Recording Consultations with Pregnant Australian Indigenous Women to Assess Use of Smoking Cessation Behaviour Change Techniques.Journal of smoking cessation · 2021Article
- Integrating Nutrition into Outpatient Oncology Care-A Pilot Trial of the NutriCare Program.Nutrients · 2020Article
- Perceptions of Oncology Providers and Cancer Survivors on the Role of Nutrition in Cancer Care and Their Views on the "NutriCare" Program.Nutrients · 2020Article
- Utility of Using Cancer Registry Data to Identify Patients for Tobacco Treatment Trials.Journal of registry management · 2019Article
- Nondaily Cigarette Smoking Is Increasing Among People With Common Mental Health and Substance Use Problems in the United States: Data From Representative Samples of US Adults, 2005-2014.The Journal of clinical psychiatry · 2018Article
- Electronic cigarettes: a review of safety and clinical issues.Journal of addiction medicineReview
- From Attitude to Action: Identifying the Knowledge and Practice Gap in Smoke-free Home Promotion Among Texas Community Health Workers and Health Education Specialists.Journal of primary care & community healthArticle
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
backgroundThe widely recommended 5A's strategy for brief smoking cessation includes five tasks: Ask, Advise, Assess, Assist, and Arrange. Assessments of the 5A's have been limited to medical-record review and self-report. Using observational data, an instrument to assess the rate at which the 5A's are accomplished was developed.
methodsThe 5A's Direct Observation Coding scheme (5A-DOC) was developed using published 5A's guidelines and was refined using observed clinician-patient interactions. The development sample consisted of 46 audio-recorded visits of smokers with their physician (n=5), collected in 2000. The 5A-DOC was next applied to a second sample of 131 visits with 28 physicians between 2005 and 2008. Inter-rater reliability was assessed and frequencies reported. Analyses were completed in 2008.
resultsThree observations shaped the development of the 5A-DOC: (1) patients accomplish 5A's tasks; (2) some communication actions accomplish multiple 5A's tasks simultaneously; and (3) sequence is important. Inter-rater agreement for identifying each task was moderate to excellent (kappa=0.58-1.0). When smoking status was established (Ask, n=78), 61% Assessed readiness, and 50% contained Assist. In all, 73% failed to complete the 5A's adequately.
conclusionsAccounting for patient activity in smoking-cessation discussions is essential to accurately capture the degree to which the 5A's have been accomplished. The 5A-DOC can be applied to audio or transcript data to reliably assess which of the 5A's tasks have been accomplished. Clinician performance of the 5A's was modest, and findings suggest that clinician training should focus on Assess and the timing of this task, and alignment with patients' reported readiness.
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