You never know the impact that Very Brief Advice can have on helping someone quit smoking
Sheila Hodges, a general practice nurse in Manchester, discusses the realities of delivering Very Brief Advice (VBA).
I can arrange telephone follow ups and keep the door open
Very Brief Advice has always been part-and-parcel of my routine for when I see a patient for any kind of check-up, or for a chronic disease review. I ask them about their smoking habit and if they are interested in stopping. If I see somebody who has expressed an interest in stopping smoking, I discuss some of the options with them, and then arrange follow-up on a monthly basis. It’s routine.
Recently, my advice about stopping smoking has developed more because I did a non-medical prescribing course. This means that I can now I prescribe stop smoking treatments for patients directly. That has helped a lot because I can give them something to help with their quit attempt, immediately. I arrange telephone follow-ups with people to check they’re getting on well with the treatment which keeps the door open if they are having any problems quitting. They are very short consultations, so I am not really digging deep into their smoking behaviour. In Manchester, we’ve got a new smoking addiction service, led by nurses who see patients within two weeks. I can refer patients to this service and it is a much-needed add-on to what we’re doing in general practice.
It’s important to deliver VBA because you never know the impact it will have on someone to give up smoking. I’ve often been surprised. I’ll have people that I’ve been seeing for years, and every time I’ve asked them about their smoking habit, and asked them if they would want to stop, it’s been a definite “No.” And then one day I mention it as I always do, and they say, “Actually, yeah, tell me a bit more about this smoking cessation drug, Champix, I’ve heard about this” or “I’m thinking about stopping.” If you don’t give patients VBA every time you see them, you might miss that opportunity when they were thinking about stopping smoking.
Sometimes clinicians might worry that the patient will be defensive
There are some perceived barriers to delivering VBA. Lack of time being number one. A doctor or a nurse may worry VBA will be the start of long conversation, or a difficult or defensive one. Others might not be quite sure what type of therapy is available, or not sure if there might be interactions of medications. That fear may cause them not to ask the question at all in a consultation. This is where training is so important to address those concerns and give clinicians the tools to use VBA.
Let your patient know that if ever they decide to stop smoking, they can come back and see somebody
There is no harm in always delivering VBA. That’s why it works. If somebody’s coming in for a check-up for their respiratory condition, for a cervical screening appointment, or any other type of appointment, the patient can be asked whether they smoke.
I would say to somebody who’s nervous of asking, go for it. It doesn’t need to be any more than, “Oh, we’ve not asked for you a while, are you still a smoker? Did you know what treatments are available? How do you feel about that? If you change your mind, come back and see us.” You know, it can be as brief as that.
It helps if you’ve got some quick phrases you can use; “Can I ask, are you still smoking?” “How many do you smoke?” “Would you like support or to be referred to anybody to help you stop?” Any health care professional asking if a patient smokes and offering them support can help them stop smoking.
Keep the doors open. It’s crucial to let patients know that if they ever decide to stop smoking, they can come back and see somebody who can help them.
The Taskforce for Lung Health, along with Asthma UK and the British Lung Foundation, are calling for training in VBA to be routine for all health care professionals. Read the Taskforce's recommendations for smoking cessation, here.