The important role of health professionals in smoking cessation
Tobacco smoking is the largest preventable cause of death, disease, illness and disability in Australia. Many of the adverse health effects of smoking are reversible by cessation.
Research shows that health professionals play an important role in interventions to encourage more quit attempts and to increase success rates.
- Almost 20% of Australian general medical practitioner patient encounters are with daily smokers and 5% are with occasional smokers (Britt et al, 2000)
- Health professionals are a respected source of preventative information and by giving just brief advice (less than 3mins) can help 2% of smokers to quit.
- Brief cessation advice to smokers from doctors delivered opportunistically during routine consultations increases abstinence rate at 6 months by 30%.
- As well as its direct effect, advice from a doctor to quit smoking has a priming effect on patient responses to other smoking cessation interventions (Kreuter et al, 2000)
- All health professionals can be effective in providing smoking cessation advice
- 50% of smokers would quit if their oral health professional advised them to (NIH, USA 1994)
- Patients have a positive attitude about their oral health professional providing them with smoking cessation advice (JADA 1999,USA).
Training of health care professionals in brief intervention methods increases their performance.
The focus of Quit Victoria's health professional training program is to encourage and support health professionals to develop and implement effective smoking cessation practices as part of routine care. Quit's approach has been to take a research-based smoking cessation training model, known as the 5As, and adapt its content and delivery for a range of settings to increase relevance of, and accessibility to, training.
Quit's training focus and direction is consistent with that of the National Tobacco Strategy 2004-2009.
The strategy is to provide tailored smoking cessation intervention training for health professionals that increases their confidence and ability to support their patients to quit and that links them to the additional services available from Quit when time constraints do not allow extended support within the practice.
To learn about training opportunities, please access Quit's training programs for health professionals.
The 5As Framework
The 5As is an international smoking cessation intervention framework that recognises time is a limited commodity in health settings. It can be used by health professionals to raise the smoking issue and encourage and support patients who smoke to quit. The 5As helps to provide health practitioners with the knowledge, skills and confidence needed to provide brief effective smoking cessation advice to their patients and to explore a systems approach to smoking cessation intervention in the health setting.
The 5As is referred to by the US Public Health Service Report, A clinical practice guideline for treating tobacco use and dependence, and has formed the basis of the 2004 Australian GP Smoking Cessation Guidelines.
When used progressively, in as little as 3 minutes, the 5As can be effective in encouraging and supporting smoking cessation.
The 5As are to:
1. Ask about smoking at each visit,
2. Assess the patient's willingness and confidence to quit and note the stage they are at with their smoking and quitting,
3. Advise the smoker to quit based on the health effects, as well as the benefits to be gained from quitting,
4. Assist the patient with quitting according to which stage they are at with their smoking,
5. Ask again at a subsequent visit. Ask smokers if they have reconsidered quitting or check progress of patients who have quit or are trying to quit. If an attempt to quit has not been made, the 5As are used again.
The model is particularly useful as it enables the health professional to do a very brief intervention, and combine that with referral to another service such as the Quitline for more extended support to the smoker, OR to do more intensive support themselves if time allows.
The 5As can link into the patient's consultation, for example when:
- welcoming the patient, you can ask and assess their smoking status and motivation to quit and record this as part of their health record
- discussing their health issues, you can ask whether your patient smokes and link your advice to their overall health
- offering options, you can assess their confidence and willingness to quit and with advice, encourage and assist them to quit depending on where they are at with their smoking
- you're following up with them again at their next visit, you can ask them again how they're going
Why assist patients to quit smoking?
The research tells us that:
- health professionals are a respected source of preventative information and giving just brief advice (less than 3mins) can help 2% of smokers to quit; this can have quite an impact at the population level if all health professionals were involved
- patients also had a positive attitude about their health professional providing them with smoking cessation advice.
View the 5As framework for health professionals flowchart (PDF 137 KB).
The 5As framework incorporates, to whatever degree is relevant or possible within time limits, health effects of smoking and benefits of quitting, smoking behaviour, the stages of change model (shown below), quitting strategies and medications and motivational interviewing techniques.
Quit Victoria provides brief intervention training focusing on the 5As framework helping health professionals to further support their patients or clients with their smoking cessation efforts. The stages of change model (below) is also discussed as part of the framework.
Stages of change model
Quitting is a lot more than just suddenly stopping smoking or one single event. The stages of change model highlights the number of stages a smoker could present in their readiness to quit. The stages of change model is built within the 5As framework so that health professionals can assess a smoker's motivation to quit and support them accordingly.
Quitline online referral
The 5As model encourages health professionals to utilise Quit services, in particular the Quitline, where with the patient/client’s permission a Quitline online referral form is filled out. Once the referral form is received by Quitline, a Quitline Advisor will contact their patient/client within a week to provide ongoing smoking cessation assistance or to assist them with any questions they may have leading up to their quitting efforts.
VicHealth Centre for Tobacco Control, Tobacco Control: A Blue Chip Investment in Public Health, The Cancer Council Victoria, Melbourne, 2001