1.1 Brief Interventions in Health and Community Care
Brief interventions involve opportunistic advice, discussion, negotiation, or encouragement. They are commonly used in many areas of health promotion and are delivered by a range of primary and community care professionals.
For smoking cessation, brief interventions typically take between 5 and 10 minutes and may include 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 National Health Service (NHS) Stop Smoking Services.
The particular package that is provided will depend on a number of factors, including the individual's willingness to quit, how acceptable they find the intervention on offer and the previous ways they have tried to quit. See Diagram 1 in the original Guideline Document for a summary of this care pathway.
1.1.1 Practice Recommendations
Who Should Receive Advice?
Recommendation 1: Everyone who smokes should be advised to quit, unless there are exceptional circumstances*. People who are not ready to quit should be asked to consider the possibility and encouraged to seek help in the future. If an individual who smokes presents with a smoking-related disease, the cessation advice may be linked to their medical condition.
Recommendation 2: People who smoke should be asked how interested they are in quitting*. Advice to stop smoking should be sensitive to the individual's preferences, needs and circumstances: there is no evidence that the "stages of change" model** is more effective than any other approach.
Who should advise smokers and how?
Recommendation 3: General practitioners (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 (for example, NHS Stop Smoking Services). If they are unwilling or unable to accept this referral they should be offered pharmacotherapy in line with National Institute for Health and Clinical Excellence (NICE) technology appraisal guidance no. 39 (available from: www.nice.org.uk/TA039) and additional support. The smoking status of those who are not ready to stop should be recorded and reviewed with the individual once a year, where possible.
Recommendation 4: Nurses in primary and community care should advise everyone who smokes* to stop and refer them to an intensive support service (for example, NHS Stop Smoking Services). If they are unwilling or unable to accept this referral they should be offered pharmacotherapy by practitioners with suitable training, in line with NICE technology appraisal guidance no. 39 (available from: www.nice.org.uk/TA039), and additional support. Nurses who are trained NHS stop smoking counsellors may "refer" to themselves where appropriate. The smoking status of those who are not ready to stop should be recorded and reviewed with the individual once a year, where possible.
Recommendation 5: All other health professionals, such as hospital clinicians, pharmacists, and dentists, should refer people who smoke* to an intensive support service (for example, NHS Stop Smoking Services). If the individual is unwilling or unable to accept this referral, practitioners with suitable training should offer a prescription of pharmacotherapy in line with NICE technology appraisal guidance no. 39 (available from: www.nice.org.uk/TA039), and additional support. Those who are trained NHS stop smoking counsellors may "refer" to themselves. Where possible, the smoking status of those who are not ready to stop should be recorded in clinical records and reviewed with the individual once a year, where possible.
Recommendation 6: Community workers*** should refer people who smoke* to an intensive support service (for example, NHS Stop Smoking Services). Those who are trained NHS stop smoking counsellors may "refer" to themselves.
*Occasionally it might be inappropriate to advise a patient to quit: for example, because of their presenting condition or personal circumstances.
**DiCLemente CC, Prochaska J, et al. (1991) The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology. Vol 59(2) 295-304.
***Community workers are practitioners working outside the health sector who have a remit for smoking cessation.
1.2.2 Strategic Recommendations for Policy Makers, Commissioners and Managers
Recommendation 7: Strategic health authorities, NHS hospital trusts, primary care trusts (PCTs), community pharmacies, local authorities, and local community groups should review smoking cessation policies and practices to take account of the recommendations in this guidance.
Recommendation 8: Smoking cessation advice and support should be available in community, primary, and secondary care settings for everyone who smokes. Local policy makers and commissioners should target hard to reach and deprived communities including minority ethnic groups, paying particular attention to their needs.
Recommendation 9: Monitoring systems should be set up to ensure health professionals have access to information on the current smoking status of their patients. This should include information on: a) the most recent occasion on which advice to stop was given, b) the nature of advice offered, and c) the response to that advice.
