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• W4238069612 abstract "We thank Dr Braillon for taking the time to read and comment on our study.1Tanner N.T. Thomas N.A. Ward R. et al.Association of cigarette type and nicotine dependence in patients presenting for lung cancer screening.Chest. 2020; 158: 2184-2191Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar We appreciate the opportunity to respond. Overall, we agree with many comments; however, we believe our message may have been misinterpreted. Yes, nicotine is addictive, and cessation is a long journey. As tobacco treatment researchers and specialists, we agree and would never suggest otherwise. The results of our research, which are consistent with clinical practice guidelines,2Barua R.S. Rigotti N.A. Benowitz N.L. et al.2018 ACC expert consensus decision pathway on tobacco cessation treatment: a report of the American College of Cardiology Task Force on Clinical Expert Consensus documents.J Am Coll Cardiol. 2018; 72: 3332-3365Crossref PubMed Scopus (112) Google Scholar allow us to assert that the start to this journey (not the entire path) should include a quantitative measurement of level of addiction that (1) provides the clinician with an indication of what level of pharmacotherapy to offer (long-acting nicotine replacement therapy [NRT; eg, patch], short-acting NRT [eg, lozenge], combination NRT [eg, patch plus lozenge], or prescription pharmacotherapy [eg, varenicline]), and (2) provides the patient with a barometer to begin to evaluate and consider their degree of tobacco dependence. It can serve as a conversation starter. We agree that the 5 ‘A’s are not always successfully implemented and offer that the single question of time to first cigarette may trigger the clinician to initiate thoughtful conversations about tobacco use, dependence, treatment options, and downstream health outcomes with the patient. We unequivocally support motivational interviewing as an evidenced-based approach to behavior change.3Lundahl B.W. Kunz C. Brownell C. Tollefson D. Burke B.L. A meta-analysis of motivational interviewing: twenty-five years of empirical studies.Research on Social Work Practice. 2010; 20: 137-160Crossref Scopus (612) Google Scholar This goal-oriented style of communication operates on the tenet that the motivation to change is determined by the patient, not the practitioner. Within the auspices of tobacco treatment, motivational interviewing has been shown to have a statistically significant impact on abstinence as compared with control. It is the opposite of finger pointing and shaming and instead focuses on the patient’s perception of the situation, with empathy, acceptance, affirmation, and support of individual autonomy. The important assumption is that the practitioner is fostering the patient’s (not the practitioner’s) internal motivation, resources, and the responsibility for overcoming ambivalence toward behavior change. Interactions with health-careproviders are an opportunity to increase motivation to quit. Facilitating tobacco treatment should include skills-based counseling and quantitative assessment of addiction at appropriate times during the individual’s cessation journey. Successful treatment usually requires multimodal interventions, including pharmacotherapy, counseling, and motivational interviewing. Education programs for practitioners, professional students, and medical trainees should provide strong emphasis of all available evidence-based techniques to give patients the best possible chance for success. Association of Cigarette Type and Nicotine Dependence in Patients Presenting for Lung Cancer ScreeningCHESTVol. 158Issue 5PreviewIn a screening population, the type of cigarette smoked is associated with different levels of dependence. Eliciting type of cigarette and time to first cigarette has the potential to allow for tailored tobacco treatment interventions within this context. Full-Text PDF" @default.
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• W4238069612 title "Response" @default.
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