How to provide effective smoking advice - in less than a minute without offending the patient

GP barriers
• Low yield from intervening6
• Reluctance to upset patients due to patient sensitivity about smoking19
• Perceived lack of patient motivation19
• Lack of GPs' time20
• Lack of skills: only 50% of GPs believe they are effective in assisting
   smokers to quit19
• Failure to use effective strategies (eg. pharmacotherapy, motivational
   interviewing, setting a quit date) or use of ineffective strategies (e.g. 
   nicotine fading, acupuncture).15

What works?
Effective smoking cessation by GPs require two sets of interrelated activities:
1. Using effective smoking cessation strategies, eg. the 5As1,9
2. Embedding smoking cessation within a supportive practice 
    infrastructure.21-23

 The 5As
The core elements of effective brief interventions by GPs (and other primary health care professionals) are captured in the 5As.

Ask
• Ask about smoking status (and interest in quitting) on ALL patients
   who attend the practice by handing out a case note sticker (or brief
   prevention questionnaire) and asking the patient to complete it.
   (A brief prevention questionnaire is provided as an appendix in the  
    RACGP 'Green book' www.racgp.org.au/publications)
• Document tobacco use in the case notes (or electronic record) in 
   every patient.

Assess
• The smoker's interest in quitting, eg. 'How do you feel about your
   smoking? How important is quitting for you right now?
• Their motivation to quit, eg. 'On a scale of 1-10 where 1 = not
    interested in quitting and 10 = very interested, where would you place
    yourself right now?'

If patients rate themselves low, eg. 3 or 4 ask: 'What would need to happen to make this a score of 9 or 10?' If they rate themselves high, e.g. score 8-9 ask: 'What makes this score 8-9 rather than 3-4?'24
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