This article, the first in a five-part series on the nurse’s role in smoking cessation, looks at the effectiveness of brief interventions and referral to stop smoking services
Smoking causes 200 premature deaths in the UK every day (Department of Health, 2017). An estimated 15.5%of adults in the UK smoke (DH, 2017) and, although this represents a big improvement from 1974, when 46% of the adult population smoked (Action on Smoking and Health, 2018), it shows how much more there is to do to reduce the number of people who smoke.
The outlook for lifelong smokers is not as positive as that for the general population; they are more likely than non smokers to develop chronic respiratory disease, a serious heart condition or cancer. Such patients face the challenge of living with their smoking-related condition, and the ever-present limitation of disability that has been caused by their illness can become their identity.
Nurses are ideally placed to intervene to help people stop smoking and change their life stories. As part of creating a smoke-free NHS, the DH’s (2017) tobacco control plan for England urges NHS trusts to make training available for all health professionals on how to help patients to quit smoking.
Guidance published by the National Institute for Health and Care Excellence recommends that all patients who smoke are:
- Advised and encouraged to stop;
- Given the support they need (NICE, 2018; NICE, 2013).
The Royal College of Physicians (2018) emphasises the need to address smoking in patients using secondary care as well as those in primary care, stating “Our NHS should be delivering default, opt-out, systematic interventions for all smokers at the point of service contact”. However, the British Thoracic Society’s (2016) smoking-cessation audit report showed that, on admission to hospital, around 19 in 20 patients were never asked more than a cursory question about smoking. Assessments were completed for these patients but the intervention that should have happened – brief advice on smoking cessation to patients who smoked – was absent. Healthcare workers should be trained to give very brief advice (VBA) (RCP, 2018).
NICE (2018) guidance recommends that primary and community care practitioners give VBA that takes less than 30 seconds to deliver to patients who smoke (Fig 1).
However, a survey undertaken by Rosenberg et al (2019) for Cancer Research UK found that only around half of primary and community health practitioners reported frequently completing VBA. Approximately 40% of practitioners perceived that patients were unreceptive to smoking-cessation advice and 15% were concerned about negative patient reactions.
Nursing Times – Feb 10, 2020.