Section 3 - Brief Intervention the Process
This section covers:
Abbreviated flowchart based on brief intervention
This section consists of an interactive exercise which will help you to think about how you can raise the issue of smoking.
The exercise is based around the full brief intervention flowchart developed to support the recommendations of A Guide to Smoking Cessation in Scotland 2010. The section of the Guide called Helping smokers to stop gives comprehensive guidance on delivering a full brief intervention but recognises that if time does not allow for this, benefits will still be gained by asking a patient:
- If they smoke; and if they do
- Have they ever thought about the impact of smoking on their general health and/or oral health?
- Would they consider stopping smoking?
- If they would like to stop, would they like to be put in touch with local services to help them stop or given details of such services?
Remember, it is always important to assess whether or not it is the most appropriate time and place to deliver a brief intervention. If after considering the appropriateness of the situation, you feel it is right to raise the issue of smoking, then you should follow the steps in this flowchart.
You can see the full brief intervention flowchart by clicking on the link below:
http://www.healthscotland.com/uploads/documents/13774-HelpingASmokerToStopSmoking_What%E2%80%99sInvolved_BriefInterventionsFlowchart.pdf
Step 1
Ask the individual whether they smoke Further information
"Yes I smoke"
If they are smoking, record this in any patient notes (if applicable to your job role). Try to establish if they realise how dangerous smoking could be for them personally. It is difficult not to ask a leading question, but you can start by asking if they are aware of the risks.
‘I don’t smoke’ OR ‘I used to smoke but I quit’
- Congratulate their achievement
- If applicable record this in any notes you have on the individual such as medical notes or patient file. There is a requirement for some health professionals, such as GPs, to record the smoking status of clients within a patient’s notes. However not everyone will keep notes on individuals or patients as this will depend on your job role.
Step 2
Ask if they are interested in trying to stop smoking
'Yes, I'm interested in stopping'
However, the person may say yes because they know this is the 'correct' answer. If they seem unsure about stopping, emphasise that support is freely available. It will increase their chance of stopping. If they remain uninterested give them Aspire magazine or another leaflet about health risks, and record what has happened in the notes (if applicable).
‘No I don’t want to stop’ OR ‘It’s not the right time for me now’
- Accept that they are not interested in a non-judgemental manner
- Leave the offer of future help open as they may change their mind
- Provide them with appropriate leaflet material such as Aspire magazine
- Record this in their notes (if applicable).
Step 3
Would you like to be given contact details for local services?
- 'Yes, I'm interested in this type of support'
- 'No, although I want to stop smoking I'm not interested in this type of support'
'Yes, I'm interested in this type of support'
Discuss services available and give Smokeline number - 0800 84 84 84 for patients to find out about other local services and they can then make an informed choice to the service they join.
‘No I don’t want to stop’ OR ‘It’s not the right time for me now’
- Accept that they are not interested in a non-judgemental manner
- Leave the offer of future help open as they may change their mind
- Provide them with appropriate leaflet material such as Aspire magazine
- Record this in their notes (if applicable).
Conclusion
Well done. You have just worked through the process of delivering brief advice to stop smoking.
Now repeat this click through exercise a few times, thinking about a range of different responses (yes or no) that you might have from different individuals.
Key points
- Delivering a brief intervention is about triggering a quit attempt, NOT providing support.
- A person’s decision to quit must be their own. You can however use factual information and your knowledge to encourage someone to quit smoking, although their right to make their own decision must be respected.
- People that use a combination of support from local cessation services and medications are around four times more likely to succeed than those who make a quit attempt without such support. reference 1
- Despite this, you must recognise that some people will want to try and stop smoking without the help of such treatment services. reference 1
- Most ex-smokers have tried to stop 3-4 times before they have successfully given up. Relapse is therefore part of the quitting process.
- By 'Raising the issue of smoking' and encouraging smokers to use local stop smoking services you are offering them the best chance of successfully stopping smoking.
- Any information you give to someone during brief advice should be factual, selectively chosen for the individual and appropriate to the individual.
Further information
- Have a think about the different ways you could find out this information. What types of question you might ask the person? Think about a number of different situations and the varying types of questions you could ask
- Think back to the evidence of the effectiveness of brief advice that was covered in section 2. If you do not have access to patient notes, how could you assess whether brief advice has recently been provided? What types of questions might you ask?
Go back to step 1
Resources
There are many different leaflets available that cover smoking, the health effects and tips on quitting which may be suitable to give people when delivering brief advice.
We have already mentioned the Aspire magazine which is a suitable leaflet to support the process of delivering brief advice. Aspire can be obtained from your local health board library or online through Health Scotland at :
http://www.healthscotland.com/documents/313.aspx
Select the resource you think is most appropriate for the person you are raising the issue of smoking with. Although the flowchart diagram uses Aspire magazine as an example, there are other resources which may be more suitable for some individuals than for others. For example: smoking & oral health, smoking & pregnancy, passive smoking, young people's leaflets.
Health Scotland produce a variety of resources relating to smoking which are available and may be suitable for the delivery of brief advice. The following website link provides details of these leaflets:
www.healthscotland.com/resources/publications/search-result.aspx
It is also important that you have accurate and up to date information about local stop smoking services in your area so that, if necessary, you can provide an individual with this information when you are providing brief advice to stop smoking.
You can now proceed to section 4