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Clinical guidelines

Supporting smoking cessationA guide for health professionals

Behavioural and advice-based support for smoking cessation

Although many smokers are likely to attempt quitting unassisted, this approach has a low likelihood of succeeding (3–6% success rate) on any given attempt.11,141,142 The most successful quit approach for those who are nicotine-dependent is counselling and support combined with first line pharmacotherapy and follow-up.11,139,143 Health professionals should offer to assist their patients/clients with a quit attempt, using pharmacotherapy and counselling, either within the health service or by referring them for intensive support to a telephone Quitline (13 7848),51 or to a tobacco treatment specialist.

Health professionals should be aware of extravagant claims of success for interventions that have not been subjected to rigorous testing and for which there is no clinical evidence.

The following smoking cessation interventions have been proven to be effective.

Brief motivational advice from health professionals

There is strong evidence that advice from health professionals (doctors, nurses, nurse practitioners, Aboriginal health workers, medical assistants, dentists, hygienists, respiratory therapists, mental health counsellors, pharmacists) is effective in encouraging smoking cessation.27–31,42Health professionals can make a difference with even a minimal (less than 3 minutes) intervention RR 1.66; 95% CI: 1.42–1.94).27 More intense interventions can result in better outcomes, but may not be practical in many clinical contexts.11 (See page 8, The role of health professionals.)

Every smoker should be offered at least a brief intervention for smoking cessation, which should include one or more of the following:144

  • simple opportunistic advice to consider quitting
  • an assessment of the smoker’s commitment to quit
  • offer of pharmacotherapy and/or behavioural support
  • self-help material
  • referral to more intensive, proactive support such as Quitline (13 7848), a tobacco treatment specialist or cessation program.

Evidence

Brief smoking cessation advice from health professionals delivered opportunistically during routine consultations has a modest effect size, 
but substantial potential public health benefit. Level I

Recommendation

Offer brief cessation advice in routine consultations whenever possible (at least annually). Strength A

References

  1. Fiore MC, Jaén CR, Baker TB, Bailey WC, et al. for the Guideline Panel. Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, May 2008. Available at http://www.ncbi.nlm.nih.gov/books/NBK63952/ [accessed 20 March 2011]
  2. Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev 2008, Issue 2. Art. no. CD000165.
  3. Sinclair HK, Bond CM, Stead LF. Community pharmacy personnel interventions for smoking cessation. Cochrane Database Syst Rev 2004, Issue 1. Art. no. CD003698.
  4. Carr A, Ebbert J. Interventions for tobacco cessation in the dental setting. Cochrane Database Syst Rev 2006, Issue 1. Art. no. CD005084.
  5. Rice VH, Stead LF. Nursing interventions for smoking cessation. Cochrane Database Syst Rev 2008, Issue 1. Art. no. CD001188.
  6. Litt J, Ling M-Y, McAvoy B. How to help your patients quit: practice based strategies for smoking cessation. Asia Pac Fam Med 2003;2:175–9.
  7. Joyce AW, Sunderland VB, Burrows S, McManus A, Howat P, Maycock B. Community pharmacy’s role in promoting health behaviours. J Pharmacy Prac Res 2007;37:42–4.
  8. Borland R, Balmford J, Bishop N, et al. In- practice management versus quitline referral for enhancing smoking cessation in general practice: a cluster randomized trial. Fam Pract 2008;25:382–9.
  9. Tønnesen P. Smoking cessation: how compelling is the evidence? A review. Health Policy 2009;91 Suppl 1:S15–25.
  10. Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 2004;99:29–38.
  11. Baillie A, Mattick R, Hall W. Quitting smoking: estimation by meta-analysis of the rate of unaided smoking cessation. Aust J Public Health 1995;19:129–31.
  12. Foulds J, Schmelzer AC, Steinberg MB. Treating tobacco dependence as a chronic illness and a key modifiable predictor of disease. Int J Clin Pract 2010;64:142–6.
  13. National Institute for Health and Clinical Excellence. Public health guidance 10. Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities. NICE, February 2008.
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