Smoking Cessation Interventions

Smoking Cessation Interventions; Behavioural interventions

Minimal clinical intervention consists of brief cessation advice from health care providers delivered opportunistically during routine consultations to smokers whether or not they are seeking help with stopping smoking. Brief opportunistic advice typically involves asking patients about their current smoking, advising them to stop, offering assistance either by providing further advice, a referral to a specialist service, or recommendation of, or a prescription for, pharmacotherapy, and arranging follow up where appropriate. This approach has been described as the 5As interventions (Table 1). The duration of each session of minimal intervention is usually three to five minutes, and certainly less than ten minutes ⁽²⁵⁾. Barriers to the provision of smoking cessation advice by all health professionals should be identified and addressed. 'Lack of time' for example is often cited as a barrier to provision of advice, yet the evidence confirms that clients can effectively be encouraged, advised and supported to quit within as little as 3-5 minutes of a health professional's time. Lack of perceived skills or training is another cited barrier, but existing evidence is mixed regarding the added benefit of intensive cessation skills training. Lack of immediate relevance is another barrier for health care providers who do not perceive a direct link between smoking and the reason for presentation of their client/patient. However, smoking has such a diversity of health effects that most health professionals will see clients who have some smoking related health problem or complication that is relevant to their consultation. 3. Intensive clinical intervention Brief advice from a heath care provider is recognized as an important motivator for a quit attempt ^(9,26). However, the 5As approaches to minimal intervention stress the importance of assisting clients to make a cessation attempt. This may include more intensive behavioural therapy .A range of more intensive behavioural methods has been used in clinical settings to support patient attempts at smoking cessation.		These include: • Individual counselling • Supportive group sessions • Aversion therapy Individual behavioural counselling Intensive interventions by health care providers are usually defined as those that take more than ten minutes per session ^(12,27,28). The distinction between minimal and more intensive intervention becomes somewhat blurred when the clinician provides continuing support of short duration per session. Individual counselling was limited to counselling provided by specialist counsellors and not by health care providers during usual care. Counselling was also required to be of at least 10 minutes duration. The counselling interventions typically included the following components: - Review of the participant's smoking history and motivation to quit; - Help in identification of high-risk situations and smoking cues; and - Generation of problem-solving strategies to deal with high-risk situations. Counsellors may also have provided non-specific support and encouragement and as well as written materials, video or audiotapes. The effect of intensive counselling compared to minimal counselling by a doctor was greater amongst trials with patients with, or at high risk of, smoking related disease ⁽²⁹⁾. General practitioners appear to be more willing to give advice to stop smokers with smoking related diseases ⁽³⁰⁾. This is despite evidence that smokers with smoking related diseases do not respond better to such advice than others ⁽³¹⁾.