A quick guide to smoking cessation care for primary health care nurses

By Wendy Winnall, Scientific Writer, Tobacco in Australia: Facts & Issues, Cancer Council Vic, Elizabeth Greenhalgh, Research & Policy Manager; Editor, Tobacco in Australia: Facts & Issues, Cancer Council Vic, Eileen Cole, GP Lead, Quit, Cancer Council Vic, Cathy Segan, Behavioural Scientist, Quit, Cancer Council Vic & Honorary Principal Fellow, Melbourne School of Population and Global Health, University of Melbourne 

Source: APNA Primary Times Winter 2023 (Volume 23 Issue 1)

Tobacco is the leading preventable cause of morbidity and mortality in Australia. Primary health care (PHC) nurses witness daily the health impacts of smoking in their patients and the significant burden tobacco use places on general practice. PHC nurses can support patients who smoke to quit using a quick guide found at Quit Centre: the 3 simple steps of Ask, Advise, Help (AAH) brief advice for smoking cessation. 

In 2019, 11% of Australians aged 14 and over reported smoking daily.¹ Two in every three deaths among people who smoke are attributable to smoking,² with nearly 20,500 tobacco-related deaths occurring in Australia in 2018.²  

The 2018 Australian Burden of Disease study highlights that tobacco use was causally linked to the burden of 41 individual diseases, including ​cardiovascular diseases​, chronic lung disease​, pregnancy complications and 16 different types of cancer.²  

Despite tobacco’s contribution to ill-health, it has traditionally been viewed as a lifestyle choice rather than as an addiction for which effective treatments are readily available.  

The majority of people who smoke make multiple quit attempts, and many are motivated by concern about the impact of smoking on their health and fitness.³ For people who smoke, advice and support provided by a nurse increases their likelihood of quitting.⁴ Quitting smoking is one of the most important actions a person can take to improve their health. 

Quit Centre’s latest resources have been developed for PHC nurses, recognising the key role of nurses in preventative health care and chronic disease management. 

The most effective way to stop smoking is by using clinically appropriate pharmacotherapy combined with multi-session behavioural counselling (such as Quitline’s free callback counselling service).⁵ Pharmacotherapy helps people to manage symptoms of nicotine withdrawal whereas behavioural intervention focuses on changing habits and routines and developing alternative coping strategies to help people move towards a life without smoking. First-line pharmacotherapies include nicotine replacement therapy (formulations include patch, lozenge, gum, mouth spray, inhalator), varenicline and bupropion.⁶  

Structuring a conversation about smoking using 3 simple steps, Ask, Advise, Help (AAH) brief advice for smoking cessation, enables health professionals, including PHC nurses, to connect patients to best-practice cessation care. Nurses can take every clinically appropriate opportunity to ask patients about smoking (Ask), share information about the health benefits of quitting (Advise), and provide an offer of help, including referral to Quitline (Help). Quitline is a welcoming, confidential and evidence-based telephone counselling service delivered over multiple sessions. Quitline counsellors assess the person’s smoking history and will help to build their motivation and confidence to quit using psychoeducation and skills-building strategies tailored to their unique situation.​ 

Nurse-led interventions can increase the likelihood of smoking cessation.⁷ A Cochrane review on strategies to improve smoking cessation rates in primary care found that adjunctive counselling provided by a health professional other than the primary care physician, including a practice nurse, increased quit rates.⁷ An Australian trial found that a PHC-nurse-led cessation intervention appeared to be effective among patients who were engaged with and completed treatment.⁸  

For people who smoke, advice provided by a nurse increases their likelihood of quitting. 

The AAH guide is available at the Quit Centre, a national online resource for health professionals. Quit Centre’s resources and training have been developed by health professionals for health professionals, to support and enable them to routinely provide cessation care. The digital resource brings into one accessible place Australian clinical guidelines, along with clinical tools, online training and the latest news and research on smoking cessation. Quit Centre’s latest resources have been developed for primary health care nurses, recognising the key role of nurses in preventative health care and chronic disease management. 

To learn more about Ask, Advise, Help (AAH), nurses can access APNA-endorsed CPD online training at Quit Centre. The ‘Smoking Cessation Brief Advice Training for Primary Health Care Nurses’ will equip nurses with the skills, confidence and knowledge to provide smoking cessation brief advice to patients who smoke. The training includes an outline of the currently available first-line pharmacotherapies and discusses the clinical considerations for their use.  

PHC nurses can visit quitcentre.org.au and subscribe to the Quit Centre Quarterly newsletter to keep ahead of the latest news, research and practice insights from other health professionals. 

The National Best Practice Support Service for Nicotine and Smoking Cessation is supported by funding from the Australian Government Department of Health and Aged Care under the Alcohol, Tobacco and Other Drugs Program. 

 

References 

1 Australian Institute of Health and Welfare (AIHW), Alcohol, tobacco & other drugs in Australia, AIHW website, 2022, accessed 29 March 2023. www.aihw.gov.au 

2 Australian Institute of Health and Welfare (AIHW), Australian burden of disease study: impact and causes of illness and death in Australia 2018, AIHW website, 2021, accessed 29 March 2023. www.aihw.gov.au 

3 Australian Institute of Health and Welfare (AIHW), National drug strategy household survey 2019, AIHW website, 16 July 2020, accessed 29 March 2023. www.aihw.gov.au 

4 VH Rice, L Heath, J Livingstone-Banks and J Hartmann-Boyce, ‘Nursing interventions for smoking cessation’, Cochrane Database Syst Rev, 2017, 12(12):CD001188, doi:10.1002/14651858.CD001188.pub5. 

5 LF Stead, P Koilpillai, TR Fanshawe and T Lancaster, ‘Combined pharmacotherapy and behavioural interventions for smoking cessation', Cochrane Database Syst Rev, 2016, 3(3):CD008286, doi:10.1002/14651858.CD008286.pub3.  

6 Royal Australian College of General Practitioners (RACGP), Supporting smoking cessation: a guide for health professionals, 2nd edn, RACGP, Melbourne, 2021. 

7 N Lindson, G Pritchard, B Hong, TR Fanshawe, A Pipe and S Papadakis, ‘Strategies to improve smoking cessation rates in primary care’, Cochrane Database Syst Rev, 2021, 9(9):CD011556, doi:10.1002/14651858.CD011556.pub2. 

8 NA Zwar, RL Richmond, EJ Halcomb et al. ‘Quit in general practice: a cluster randomized trial of enhanced in-practice support for smoking cessation’, Fam Pract, 2015, 32(2):173–180.