GPs should offer help to all smokers regardless of whether they express interest in quitting or not, concludes a recent evaluation of the evidence.
In data that raises questions over the more tentative advice that NICE gives about smoking advice, UK researchers found evidence that doctors offering help opportunistically increased the number of smokers attempting to quit.
The study comes a week after NHS Future Forum chair Professor Steve Field’s called for GPs to ‘make every contact count’ and routinely ask patients about their diet, smoking and drinking habits.
NICE public health guidelines currently recommend GPs ask people who smoke how interested they are in quitting and then, if they want to stop, offering support from a stop smoking service or pharmacotherapy.
However, researchers from the University of Birmingham and University College London looked at data from 11 studies where advice and assistance to smokers was offered opportunistically, without any assessment of the motivation of the smoker to quit.
Their analysis – published online by the journal Addiction – found advice to quit on medical grounds increased the frequency of quit attempts by 24%, and increased their success by 25%, compared with no intervention at all.
Data from two trials showed that offering NRT as well as advice to quit was even more successful, doubling abstinence rates and increasing the proportion of people quitting by 68%, compared with no intervention.
Lead author Professor Paul Aveyard, professor of behavioural medicine at the University of Birmingham said: ‘Motivation can be highly context sensitive and the offer of assistance may increase confidence in success, create a more positive image of the quitting process, or trigger a positive response out of a motivation to reciprocate.’
Dr Alex Bobak, a GP and smoking cessation adviser at Wandsworth PCT said: ‘I completely agree with this. Why would we not be offering help to all smokers?’
‘GPs need to recognise that advice to stop smoking is not good advice. Instead – once we’ve ascertained they are a smoker – we should say: “Did you know there´s support if you want to stop? The irony is that that’s a much more pleasant consultation than the confrontational approach.’
What NICE recommends
- Ask people who smoke how interested they are in quitting.
- If they want to stop, refer them to an intensive support service such as NHS Stop Smoking Services.
- If they are unwilling or unable to accept a referral, offer a stop smoking aid (pharmacotherapy)
Source: NICE public health guidance (PH1), 2006