Effective brief interventions in smoking cessation

Effective brief interventions in smoking cessation 1

According to the National Institute for Health and Clinical Excellence (NICE, 2006), Brief Intervention is:

  • Opportunistic advice, discussion, negotiation or encouragement
  • Delivered by a range of primary and community care professionals
  • Between 5-10 minutes, involving one or more of the following:
    • Simple opportunistic advice to stop
    • An assessment of the patient’s commitment to quit
    • An offer of pharmacotherapy and/or behavioural support
    • Provision of self-help material and referral to more intensive support such as the NHS Stop Smoking Services.

Brief intervention is an effective and cost-effective population based approach. Simple advice can have a significant effect on smoking cessation.

NICE Recommendations:

  • Everyone who smokes should be advised to quit.
  • People who smoke should be asked how interested they are in quitting.
  • GPs should take the opportunity to advise all patients who smoke to quit when they attend a consultation. Those who want to stop should be offered a referral to an intensive support service. If they are unwilling or unable to accept this referral they should be offered pharmacotherapy (in line with NICE guidance, 2002). The smoking status of patients should be recorded.
  • Nurses in primary and community care should advise everyone who smokes to stop and refer them to an intensive support service. If they are unwilling or unable to accept this referral they should be offered pharmacotherapy by practitioners with suitable training. The smoking status of patients should be recorded.
  • All other health professionals, such as hospital clinicians, pharmacists and dentists, should refer people who smoke to an intensive support service. If they are unwilling or unable to accept this referral, practitioners with suitable training should offer a prescription of pharmacotherapy (in line with NICE guidance). The smoking status of patients should be recorded.
  • Community workers should refer people who smoke to an intensive support service.

Click here for a summary of the NICE guidance.

The 3As approached for providing advice is advocated:

  • ASK patients about their smoking status.
  • ADVISE patients of the value of stopping smoking and the health risks of continuing to smoke. The advice should be clear, firm and personalised.
  • ACT: If the patient would like to stop, help should be offered. Refer to Stop Smoking Wales, a specialist smoking cessation service, as this offers smokers the best chance of stopping smoking.

Behaviour Change

Stopping smoking does not happen instantly. It is a process, with identifiable stages, known as the Stages of Change (Prochaska & DiClemente, 1983). Sometimes people may move through the different stages very quickly, for other people it can be a much longer process. The model is a useful tool to help healthcare professionals to assess whether a person is ready to stop smoking, in order to tailor the brief intervention they deliver.

Many people will work through each stage of the cycle several times before they succeed in stopping smoking for good. If it can be established which stage a person is at in the change process, the brief intervention can be tailored to their needs.

A person’s attitude has to change before they can effectively change their behaviour. Brief Interventions are most appropriate for people in the attitude-change stages. 

Effective brief interventions in smoking cessation 2

The Stages of Change

A description is given below for each stage of change and how a person may be supported depending on the stage they are currently at.

Pre-contemplation
Characteristics of patient:
  • Not interested in changing behaviour
  • May perceive many advantages to continuing smoking
  • Unlikely to be receptive to advice about stopping
  • May be defensive or resistant if the patient feels you are trying to persuade them to change.
How can we support a patient at this stage of the cycle?
  • Accept their position, don’t push.
  • Stay neutral and non-judgemental.
  • Ask questions about their smoking: for example, are you planning to always be a smoker? Is there anything in particular you like about smoking?
  • Remind them that support is available when they feel the time is right.
Contemplation
Characteristics of patient:
  • Thinking about making a change
  • May be concerned or unhappy with their smoking habit
  • May still have reasons for continuing to smoke
  • May be receptive to information and be willing to talk.
How can we support a patient at this stage of the cycle?
  • Encourage the patient to talk about the pros and cons as they perceive them, and find their own reasons for quitting.
  • Acknowledge both sides of how they are feeling; don’t over-do the persuasion.
  • Offer to correct myths or misunderstandings (for example, ‘the damage is already done’)
  • Provide information about Stop Smoking Wales.
Preparation
Characteristics of patient:
  • Preparing to quit smoking and is in an ideal position to benefit from Stop Smoking Wales support.
  • They have worked through their ambivalence and the benefits of quitting smoking now outweigh the benefits of smoking.
  • May be very receptive to information and advice.
  • May want to know how to quit, what works, etc.
How can we support a patient at this stage of the cycle?
  • Explain that Stop Smoking Wales will support them to prepare to quit smoking and after they have quit smoking
  • Stop Smoking Wales can provide information on NRT, Bupropion and Varenicline
  • Continue to give praise and encouragement
  • Reinforce the reasons they give for quitting.
Action, Maintenance and Relapse
Stop Smoking Wales will support people through these stages. Brief Intervention is most appropriate for attitude change stages. How can we support a patient at this stage of the cycle?
  • Keep going with support, encouragement and praise
  • Check that the patient has accessed Stop Smoking Wales, ask how things are going
  • Address relapse as a learning experience rather than a failure – ask what happened, what lead them to go back to smoking, emphasise the risk of ‘just one cigarette’, highlight the importance of trying again.

 


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