Ask, Advise, Help

SPONSORED EDITORIAL 

The vital role primary health care nurses can play in smoking cessation 

 

 

 

 

 

 

 

 

 

 

 

 

Stacey Ridley, Nurse Advisor, Quit, Cancer Council Victoria

Sacha Filia, Cessation Advisor, Quit, Cancer Council Victoria

Paulette Trevena, Senior Engagement & Communications Advisor, Quit, Cancer Council Victoria 

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As a primary health care (PHC) nurse, you can play a vital role in your patient’s health by assisting them to stop smoking, leading to immediate health benefits. A simple and effective conversation can start a patient on their quitting journey. PHC nurses can use the Ask, Advise, Help (AAH) model of brief advice for smoking cessation and partner with Quitline to maximise their patients’ likelihood of quitting. 

Smoking: A major cause of preventable death and morbidity 

PHC nurses can play an important role in the health of their patients who smoke.¹  

Despite progress in the reduction of the prevalence of smoking, it continues to be a major cause of preventable death and morbidity,²,³ claiming around 24,000 lives annually in Australia alone, and leads to a wide range of diseases, including many types of cancer, cardiovascular disease, respiratory disease, and cerebrovascular disease.² 

The health impacts are devastating – but the good news is that quitting can help to turn things around almost immediately. It leads to significant health benefits, including immediately lowering the risk of physical health problems, through to improving mental health and wellbeing.⁴ 

Why PHC nurses can play a key role in smoking cessation 

Nurses are the largest global healthcare workforce, and they’re perfectly positioned to make a real difference. A brief conversation from a nurse about smoking can be a powerful catalyst for change that could lead to could lead to a quit attempt, abstinence, and potentially save a life.¹,⁵ 

The real-world challenges 

PHC nurses often work in incredibly busy clinics, juggling many responsibilities. Some may feel overwhelmed by the idea of adding another intervention to their already packed schedules.6 Common barriers include lack of training, knowledge and confidence as well as time constraints, managing workloads, and communication issues between GPs and PHC nurses.⁶,⁷ 

Starting the conversation 

Ask, Advise, Help (AAH) brief advice for smoking cessation is the simple three-step model that makes smoking cessation conversations manageable and effective and enables health professionals to connect patients to best-practice cessation care: advice, behavioural intervention, and pharmacotherapy, if clinically appropriate.⁴ 

PHC nurses can take every clinically appropriate opportunity to ask patients about smoking (Ask), share information about the benefits of quitting and how to quit (Advise), and provide an offer of help, including referral to Quitline (Help). For example, whilst providing wound-care treatment, PHC nurses can also advise their patients that wound healing can be improved by smoking cessation.8 Similarly, when developing chronic disease care plans, PHC nurses can highlight how cessation can positively impact conditions including diabetes, asthma, chronic obstructive pulmonary disease and cardiovascular disease,8 and a quick referral to Quitline can be made. During annual influenza vaccinations, the patient can be informed of the increased risk and severity of infection, and increased rates of death from influenza in people who smoke.⁹ 

How pharmacotherapy can help 

Pharmacotherapy helps people to manage symptoms of nicotine withdrawal. First-line pharmacotherapies for smoking cessation include nicotine replacement therapy (formulations include patch, lozenge, gum, mouth spray), and stop-smoking medications (varenicline and bupropion).⁴ Multi-session behavioural intervention for smoking cessation (such as Quitline) focuses on changing habits and routines and developing alternative coping strategies to help people move towards a life without smoking. 

The Quitline partnership: a powerful resource 

PHC nurses can partner with Quitline to best support patients on their quitting journey. They can directly refer patients to the Quitline using this form: www.quitcentre.org.au/referral-form. Making a proactive referral to Quitline increases the likelihood that patients will engage with the service¹⁰ and quit smoking.¹¹ Quitline can provide the behavioural intervention, enabling nurses to focus on other aspects of smoking cessation care. This may include providing patients with information about pharmacotherapy if clinically appropriate, and in some cases, nurses can facilitate access to pharmacotherapy via the GP. 

Quitline offers free, welcoming and confidential telephone counselling that can support people to quit. Patients don’t need to ‘be ready’ to quit for a Quitline referral to be made. The professional counsellors at Quitline work with patients over several calls to explore their motivation and barriers and support them to create a personalised plan for quitting. Quitline has tailored protocols for priority groups, including people experiencing mental health conditions, pregnant people, young people under 18 years, and sexually or gender diverse people. The Translating and Interpreting Service can support patients who speak a language other than English, and people who identify as an Aboriginal and/or Torres Strait Islander are offered a First Nations Quitline counsellor. With the patient’s consent, Quitline provides feedback to health professionals about the patient’s progress. 

Empowering nurses through training 

Training is an important step in equipping PHC nurses with the skills, confidence and knowledge to provide smoking cessation brief advice to patients who smoke.5 PHC nurses can access APNA-endorsed continuing professional development online training at Quit Centre: http://www.quitcentre.org.au/online-training/for-primary-health-care-nurses. 

Visiting the website and subscribing to the Quit Centre Quarterly newsletter will support nurses to keep abreast of the latest news, research and practice insights from other health professionals. 

The National Best Practice Support Service for Nicotine and Smoking Cessation (Quit Centre) is supported by funding from the Australian Government Department of Health and Aged Care. 

 

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References 

1. R Abdelkader, RS Maabreh, R Al-Dgheim et al., ‘The impact of tobacco use and nicotine addiction on health: A literature review of nursing interventions for smoking cessation’, J Integr Nurs, 2024, 6(4):218–230. 

2. Australian Institute of Health and Welfare (AIHW), Australian Burden of Disease Study 2024, AIHW website, 12 December 2024, accessed 16 April 2025. 

3. Australian Institute of Health and Welfare (AIHW), National Drug Strategy Household Survey 2022–2023, AIHW website, 29 February 2024, accessed 16 April 2025. 

4. Royal Australian College of General Practitioners (RACGP), Supporting smoking cessation: A guide for health professionals, 2nd edn, RACGP, Melbourne, 2024. 

5. Y Jiang, Y Zhao, P Tang, X Wang, Y Guo, L Tang, ‘The role of nurses in smoking cessation interventions for patients: a scoping review’, BMC Nurs, 2024, 23(1), 803, doi:10.1186/s12912-024-02470-2. 

6. C Coleman, SG Ferguson and R Nash, ‘Barriers to smoking interventions in community healthcare settings: a scoping review’, Health Promot Int, 2024, 39(2), daae036, doi:10.1093/heapro/daae036. 

7. M Li, K Koide, M Tanaka, M Kiya and R Okamoto, ‘Factors associated with nursing interventions for smoking cessation: a narrative review’, Nurs Rep, 2021, 11(1), 64-74, doi:10.3390/nursrep11010007. 

8. U.S. Department of Health and Human Services, Smoking cessation: a report of the Surgeon General, Centers for Disease Control and Prevention website, 2020, accessed 16 April 2025. 

9. W Winnall, B Bellew, EM Greenhalgh and MH Winstanley, ‘Increased susceptibility to infection in smokers’, in EM Greenhalgh, MM Scollo and MH Winstanley (eds), Tobacco in Australia: facts & issues, Cancer Council Victoria, Melbourne, 2025. 

10. JI Vidrine, S Shete, Y Cao et al., ‘Ask-Advise-Connect: a new approach to smoking treatment delivery in health care settings’, JAMA Intern Med, 2013, 173(6):458–464. 

11. W Matkin, JM Ordóñez‐Mena and J Hartmann‐Boyce, ‘Telephone counselling for smoking cessation’, Cochrane Database Syst Rev, 2019, 5(5):CD002850, doi:10.1002/14651858.cd002850.pub4.