Table III.

Nonpatient stakeholder domains of successful smoking cessation

Stakeholder	Domain
	Feasibility or effectiveness	Infrastructure and resources	Implementation	Surgeon tone
Surgeon	Systematic approach with brief intervention is easy to do Surgeons are surprised at the numbers who refuse to participate	Support personnel Dedicated nurse, assistant Medications should be free Some states provide free medications, others do not Prescriptions should be preprinted	Systematic approach Brief intervention Referral to Quit Line Problems with feedback from Quit Line	Limit surgeon responsibility
VQI program	Should be part of the script of the normal office visit	Support Personnel Dedicated nurse or administrator Laminated card Should be nurse-run clinic, with a specific protocol	Succinct question Referral to Quit Line Medication recommendation	Limit surgeon responsibility
Smoking cessation nurse	Brief counseling plus medication works Quitting a month before surgery is ideal	Medication Quit Lines can provide patches, gum Preprinted prescriptions with patient instructions Dedicated nurse	Electronic referral Follow-up phone calls (2 weeks, 3 months, 6 months)	It is paramount that the surgeons are involved and advise in a clear tone
Tobacco consultation service manager	Six weeks before surgery is ideal Six in-person counseling sessions	Free nicotine replacement should be available	Electronic referral Quit Line refers to the counseling program	Surgeon should be informed and positive
Tobacco help line	Highly motivated population Higher success with those who self-refer 40% 30-day quit rate	Electronic system Eliminate patient barriers: Cost of medication Childcare for counseling Telephone problems	Patient called in 72 hours, then 3 attempts in a week Feedback loop to physician via fax	Surgeon initiation is key

VQI, Vascular Quality Initiative.