30 seconds - enough to help a smoker quit?

Dr Richard Roope, FRCGP, RCGP and Cancer Research UK Clinical Champion for Cancer 

It has become clear that less is more – and in the currently packed consultation, this can only be good news. Smoking cessation is one of the most successful health interventions. In the context of long term smoking having a fatality rate of over 50%, for every two smokers who quit, one smoking related death has been saved. In addition to this, the quality-adjusted life year (QALY) for smoking cessation has been calculated as just £80 over the lifetime of the patient. This indicates that smoking cessation is also one of the most cost-effective interventions.  

For many of us, smoking cessation training has not featured highly in our education as either undergraduates or since, and this largely remains the case. What has become clear is that some of the techniques adopted by health care professionals over the years have not been helpful to our patients: we now know that asking a smoker how much they smoke, trying to frighten them with morbidity and mortality statistics does not work. Instead, the approach that appears to be the most effective is "Very Brief Advice". 

Research shows that just 30 seconds can be enough to help a smoker quit. It involves 3 steps:

  • Ask
  • Advise
  • Assist

"Are you currently smoking? Did you know the best way to give up is a combination of professional support and pharmacological assistance? If you would like to give up, our smoking cessation nurse can provide that support."

If you are interested to follow this up there is a RCGP e-learning tool.

In the past few weeks, the RCGP, has changed its position on e-cigarettes. It is recognised that e-cigarettes are significantly safer than conventional smoking, and yet medical professionals and the public do not appreciate how safe they are. At the recent RCGP annual conference in Liverpool, only 22% of delegates attending the cancer update correctly identified that e-cigarettes are significantly less harmful than smoking (this compares with just 13% of the public). The current RCGP guidance includes: 

"Using their clinical judgement on an individual patient basis, PCCs (Primary Care Clinicians) may wish to promote EC use as a means to stopping. Patients choosing to use an e-cigarette in a quit attempt should be advised that seeking behavioural support alongside e-cigarette use increases the chances of quit success further. Most SSS (smoke stop services) are EC friendly and patients can be advised to bring one to their appointment if they would like to quit using their device."

This advice aligns with Public Health England and the Royal College of Physicians. More information can be found on the RCGP website. Hopefully, this will allow GPs across the four nations to give consistent advice to our patients, and as we all adopt this line, and become more confident with giving very brief advice, we may do what we all strive to do: to save lives.

Contact

Clinical Innovation and Research Centre: 020 3188 7597
circ@rcgp.org.uk

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