PALO ALTO CENTER FOR PULMONARY DISEASE PREVENTION
Checklist Developed by & Information Prepared by:
David P.L. Sachs, MD
Director, Palo Alto Center for Pulmonary Disease Prevention
Palo Alto, CA
- This is a checklist that Dr. Sachs has used in his clinical practice for the last 6 years. He realized that there were simply too many important topics that he needed to make sure he covered with each and every patient before their Target Stop Date. In some cases, he might elect deliberately not to cover a topic, but he wanted that to be an active decision, not a passive decision. All of these basic topics and concepts are discussed in detail in specific sections of the Tool Kit, but this way he makes sure whether he has actively covered it or decided not to cover it with a particular patient.
- The item labeled “Yin/Yang” refers to a graphical illustration that Dr. Sachs has created that visually emphasizes how interlinked the biological/physical side of nicotine dependence is to the psychological side of tobacco dependence. For example, when the patient has been in a stressful situation, smokes a cigarette, and feels relaxed, that creates a psychological reinforcer for using the cigarette.
- It is also clearly important to know whether or not the spouse or significant other is a smoker, since having another smoker in the household, if not adequately dealt with, renders most treatment plans and action strategies ineffective. The physician or professional office staff need to devote additional time to helping the patient think through how to create an environment that will be conducive to the patient’s stopping smoking, despite other smokers being in the household. Most household members, for example, are usually quite cooperative in agreeing to limit their smoking to only one or two rooms in the house. In many cases, the smoking family member just decides to smoke outside the house only. The important point is that the patient should not know where the family member keeps cigarettes stored at home.
- The patient may find a nonsmoking spouse or significant other supportive or hassling. This needs to be identified before Target Stop Date, so that the physician can help the patient make certain that the spouse or significant other will be a true ally in helping the patient stop smoking. Hassling never helps!
How to Use the Pre-Treatment Checklist
- Check the “Y” column when you have fully covered the topic, consistent with the patient’s needs.
- Check the “±” column when you have partially covered the topic but have elected to defer completing the discussion to a later or better time (e.g., when the patient will be better able to actually hear the information and process it).
- Check the “N” column when you have decided that you do not need to cover the topic with that patient.