Training and resources for stroke clinicians

Stroke clinicians are well placed to deliver smoking cessation brief advice to patients. A brief advice conversation helps patients access best practice smoking cessation care, and is quick and effective. Quit and Stroke Foundation have partnered to provide online training and resources to stroke clinicians, assisting them to support patients to stop smoking and improve stroke or transient ischemic attack (TIA) outcomes.

Stopping smoking and risk of recurrent stroke, severity, recovery and mortality

• Stopping smoking within the first six months after an ischaemic stroke or TIA significantly reduces risk of stroke, myocardial infarction or death within the next 4.8 years.[1]

• People who stop smoking after a first stroke reduce their risk of recurrent stroke to only 1.3 times that of a non-smoker.[2]

• Among patients who have experienced stroke, former smoking was associated with reduced risk of severe stroke, of mortality at 30 days, and of a prolonged stay at hospital when compared with current smoking. The results varied by stroke subtype.[3]

• People who have experienced stroke or TIA and stop smoking reduce their risk of all-cause mortality.[3,4,5]

Continued smoking and risk of stroke, recurrent stroke, severity and mortality

• A person who smokes a pack a day is more than 6x as likely to have a stroke compared to a non-smoker.[6]

• After an initial stroke, continued smoking increases the risk of stroke recurrence. There exists a dose–response relationship.[2]

• People who continue to smoke after a stroke have almost twice the risk of recurrent stroke in the next 2.5 years, compared to stroke sufferers who were non-smokers.[2]

• Smoking increases the likelihood of dying as a result of stroke. People who smoke have a 2-fold mortality from stroke and endure stroke disability 11 years longer.[5]

• Smoking is attributable to 11% of the total burden of stroke.[7]

In conjunction with health professionals, Quit have adapted a 3-step brief advice model: Ask, Advise, Help (AAH) which is described in the RACGP’s Supporting smoking cessation: A guide for health professionals.

It focuses on identifying people who smoke and helping them access best practice tobacco dependence treatment. Best practice tobacco dependence treatment is a combination of pharmacotherapy and multi-session behavioural intervention through Quitline (13 7848).

• Ask all patients about smoking status and document this in their case file.

• Advise all patients who smoke about the best way to stop smoking and why this is important.

• Help by offering referral to behavioural intervention through Quitline (13 7848), and help patients to access smoking cessation pharmacotherapy, such as nicotine replacement therapy (NRT).

Ask, Advise, Help can be integrated into treatment and rehabilitation care pathways for stroke and TIA patients.

• Ask, Advise, Help chart - describes the steps to take during a brief advice conversation about smoking.

• Smoking and stroke poster

• The benefits of stopping smoking for people who have experienced stroke or transient ischaemic attack (TIA) pamphlet

• 4Ds wallet cards for clients

• 'My quit plan' brochure for clients, and more.

Other resources:

• Stroke Foundation - Quit Smoking

• Stroke Foundation - Enable Me - Smokes can lead to strokes

In 2021, Quit and Stroke Foundation partnered to deliver two webinars designed to increase stroke clinician knowledge, skills and confidence in providing brief advice and linking patients with best practice tobacco dependence treatment. You can view recordings of each webinar by clicking the links below.

1. Webinar 1 (June 9th 2021): Embedding smoking cessation care into stroke settings. View recording

2. Webinar 2 (August 25th 2021): Case-studies and Quitline overview. View recording

Quitline is a confidential, evidenced-based telephone counselling service. Qualified Quitline counsellors use behaviour change techniques and motivational interviewing over multiple calls to help people plan, make and sustain a quit attempt. By referring patients to Quitline, you help them access free support and increase the chance that they will be able to make a successful quit attempt.

There are two ways to refer patients to Quitline:

• Quitline fax referral sheet

• Online referral form.

Tobacco in Australia: Facts and Issues is a comprehensive review of the major issues in smoking and health in Australia, compiled by Cancer Council Victoria.

Quit’s online Essentials training course is appropriate for stroke clinicians in any setting. There is also a Health Services course available for clinicians working in inpatient settings.

The training aims to equip stroke clinicians with the skills and confidence to deliver best practice smoking cessation brief advice to patients.

Duration: Approximately 30 minutes

Cost:

• The training is free for VIC, SA and WA learners.

• A registration fee of $20 applies for other states and territories.

Learning objectives:

• Understand who is smoking and which priority populations have higher rates of smoking.

• Understand the negative impacts of smoking on health outcomes.

• Know how to provide fast, simple and effective brief advice in a supportive non-judgemental manner.

• Understand the important role of multi-session behavioural intervention (such as Quitline) and how to refer.

• Understand the different smoking cessation pharmacotherapy options available.

• Know what additional resources are available and how to refer.

Certification: Printable certificate

How to access the training: Register for Essentials or Health Services training at education.quit.org.au, or click the button Register for online training button.

Not only can the AAH model be used by individual stroke clinicians in everyday interactions with patients, it can also be used to guide organisation-wide change to systematically embed smoking cessation care into routine practice. Quit and partners have developed tools and resources that assist health services to embed smoking cessation care into routine practice. These include clinical guidelines and pathway templates. Read more about the Ask, Advise, Help model.

[1] Epstein KA, Viscoli CM, Spence JD, Young LH, Inzucchi SE, Gorman M, et al. Smoking cessation and outcome after ischemic stroke or TIA. Neurology 2017;89(16):1723-1729.

[2] Chen J, Li S, Zheng K, Wang H, Xie Y, Xu P, et al. Impact of Smoking Status on Stroke Recurrence. J Am Heart Assoc 2019;8(8):e011696.

[3] Edjoc RK, Reid RD, Sharma M, Fang J. The prognostic effect of cigarette smoking on stroke severity, disability, length of stay in hospital, and mortality in a cohort with cerebrovascular disease. J Stroke Cerebrovasc Dis 2013;22(8):e446-54.

[4] United States. Public Health Service. Office of the Surgeon General. Smoking cessation: a report of the Surgeon General. Rockville, MD; Atlanta, GA: U.S. Dept. of Health and Human Services, Public Health Service, Office of the Surgeon General, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2020.

[5] Wang HK, Huang CY, Sun YT, Li JY, Chen CH, Sun Y, et al. Smoking Paradox in Stroke Survivors?: Uncovering the Truth by Interpreting 2 Sets of Data. Stroke 2020;51(4):1248-1256.

[6] Stroke Association, Smoking and the risk of stroke (September 2017) https://www.stroke.org.uk/sites/default/files/smoking_and_the_risk_of_stroke.pdf

[7] Australian Institute of Health and Welfare, Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015 (June 2019) https://www.aihw.gov.au/reports/burden-of-disease/burden-disease-study-illness-death-2015/summary.

Last updated: October 2021

For any queries or further information, please contact quit@quit.org.au