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Time can be a barrier for any behaviour change conversation, especially when encouraging smokers to stop, but you could trigger a quit attempt in 30 seconds using Very Brief Advice (VBA).

VBA is an evidence-based intervention delivered by a health professional aimed at raising awareness of unhealthy behaviours and encouraging behaviour change.

NICE recommend all frontline health professionals offer VBA for smoking cessation1 but despite this only half of primary care practitioners frequently complete VBA2.

VBA is easy to deliver. It can be:

  • used opportunistically in almost any consultation without pressing or challenging a patient
  • delivered across many consultations to reinforce the message of how to quit
  • delivered without knowledge of the patient’s smoking habits

There is no need to go into detail about what or how much they smoke as these questions can be discussed at a specific smoking cessation appointment. Instead VBA is simply used for offering advice and sign posting, in a way that feels supportive to the patient.

The 'AAA' framework outlined below, is a useful way to deliver VBA and prompt a quit attempt.

‘Do you smoke?’
‘Do you still smoke?’
‘Are you a smoker?’
‘I see from my notes you’ve stopped smoking, how’s that going?’

Coding e-cigarette users:
If a patient uses an e-cigarette but doesn’t smoke tobacco at all, then code as a non-smoker. If a patient uses an e-cigarette but also smokes tobacco, then code as a smoker.

‘Did you know specialist support makes you more likely to succeed in stopping smoking? You can experiment with different quitting aids to find what’s right for you’.

You could inform the patient about the support that a local Stop Smoking Service can provide, and explain that safe and effective stop smoking medications such as varenicline and bupropion are available on prescription.

If it’s relevant, explain that the Stop Smoking Service will support the use of e-cigarettes as a quitting aid if the person wants to use them.

‘I can refer you to the free local Stop Smoking Service, who will arrange treatment and support you while you quit.’

If there isn’t a local Stop Smoking Service available or the patient doesn’t want to attend, have a conversation about alternatives including asking them to come back for a dedicated consultation about medication, or if they’re interested, discuss e-cigarettes.

If they’re not interested in stopping, then try to encourage future attempts.

‘That’s fine, there are options available, just let me know if you change your mind’

‘There is help available when you are ready.’

As per NICE guidance, record the fact that they smoke and at every opportunity ask them about it again in a way that is sensitive to their preferences and needs. Don’t forget to explore your local Stop Smoking Service offer and prepare for consultations by having referral information to hand.

Complete Cancer Research UK’s 30-minute CPD module on the 'Essentials of smoking cessation' including VBA and pharmacotherapy.

This hub has been sponsored and written by Cancer Research UK.

References
  1. NICE, Clinical guideline 92: Stop smoking interventions and services. 2018
  2. Rosenberg G. et al. Smoking Cessation in Primary Care: A cross-sectional survey of primary care health practitioners in the UK and the use of Very Brief Advice. 2019.
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