A quick offer to support patients to quit smoking can be far more effective than telling them to stop. A short film that counts towards CPD can help nurses do this
Authors: Andy McEwen is senior research nurse, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London; Melanie McIlvar is senior delivery manager; Joanne Locker is delivery manager, both at National Centre for Smoking Cessation and Training (NCSCT).
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Which of us wouldn’t spend 30 seconds of our time to save a life if we could? A new short online module trains practitioners to do exactly this.
The NHS Future Forum has emphasised the importance of clinicians using every patient contact as an opportunity to maintain or improve mental and physical health and wellbeing, including issues around tobacco, diet, physical activity and alcohol (NHS Future Forum, 2012).
Advice from health professionals can be one of the most important triggers for a quit attempt. The question is how to give this advice effectively without taking up too much time or harming relationships with patients. The Very Brief Advice on Smoking training module has been designed to avoid these problems.
The traditional approach is to focus on informing smokers of the harms caused by smoking and advising them to stop. However, an offer of support is more effective. Compared with no advice to smokers, the likelihood of quitting is 68% higher if stop smoking medication is offered and 217% higher with an offer of support (Aveyard et al, 2011). A large study across the whole of England found smokers were almost twice as likely to try to stop if they had been offered help by a GP than if they had only been advised to stop (West and Fidler, 2011).
Very Brief Advice on Smoking (VBA) is part of the work of the National Centre for Smoking Cessation and Training (NCSCT) and is funded by the Department of Health. It is a simple piece of advice that is designed to be used opportunistically in less than 30 seconds in almost any situation with a smoker.
What may be surprising is that you do not advise smokers to stop, and you do not ask how much they smoke or even if they want to stop. There are three elements to VBA: establishing and recording smoking status (ASK); advising on how to stop (ADVISE); and offering help (ACT).
There is almost always an opportunity for practitioners to ask about smoking status when they see patients, whether this concerns the presenting problem or a patient’s history. Practitioners can use whatever words feel comfortable given their relationship with and what they know about their patients, and what their notes tell them.
Having found current smokers, the usual instinct is to ask if they want to stop, but this is deliberately left out of the VBA script. This is because it can immediately put patients on the defensive and raise anxiety levels. It also takes time and can generate a conversation about their smoking, which should be saved for a dedicated stop smoking consultation. Also, there is no need to ask how much someone smokes or even what they smoke. The details are better saved for the stop smoking consultation.
Next comes a simple statement advising that the best way to stop is with a combination of support and medication: “Did you know the best way to stop is with support and treatment through your local stop smoking service? They can make it much easier to stop than doing it by yourself.”
Smokers who are interested in quitting are offered local support and medication. The best option is with a trained stop smoking adviser from a local stop smoking service (Department of Health, 2012).
Delivering VBA routinely quickly becomes second nature.
The training module takes less than 30 minutes to complete and includes evidence for the VBA model, film clips modelling how to deliver VBA and advice on how to keep the intervention brief. The module also includes a short assessment that, when passed, generates a certificate as evidence of continuing professional development.
A film - 30 Seconds: a Short Film About Saving a Life is included and can be seen on the National Centre for Smoking Cessation and Training (NCSCT) YouTube channel: NCSCTfilms.
The VBA training module is free of charge and can be accessed by clicking here.
Aveyard P et al (2011) Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction. 16 December. doi: 10.1111/ j.1360-0443.2011.03770.x. (Epub ahead of print)
Department of Health (2012) Smokefree. London: DH.
NHS Future Forum (2012) The NHS’s Role in the Public’s Health: a Report from the NHS Future Forum.
West R, Fidler J (2011) Smoking and Smoking Cessation in England 2010. London: Vasco-Graphics.