“Some healthcare professionals feel disheartened by the reluctance of patients who smoke to consider quitting, but the new NICE guidance gives us new strategies to explore,” says Louise Ross.
She explains how the one applicable to smoking cessation is a long guideline, and not all of it is relevant to primary care practitioners.
Her article focuses on “key points that are easy to implement, particularly around training to effectively deliver VBA. It is possible to tailor support to the individual in a way that is a call to action rather than a rebuke, and the news that e-cigarettes are an effective way to stop smoking can be framed positively.
“Although it is extremely valuable that the NHS long term plan has developed intensive and thorough support for inpatients, it is in primary care that the majority of care for people who smoke will be delivered. Just as we encourage people who smoke never to give up giving up, we must say the same to healthcare professionals—never give up asking people if they want to stop smoking.”
The Key Points:
- Smoking-related diseases are likely to have killed a greater number of people than COVID-19 in 2020 and 2021
- Most smoking-related health problems are caused by other components in tobacco smoke, rather than nicotine
- Patients who smoke are not hard to reach; they are in primary care waiting rooms with the early signs of COPD, heart disease, or cancer
- All front-line healthcare staff should be trained to deliver VBA on smoking cessation
- Healthcare professionals should emphasise the value of NRT (strong enough, long enough, often enough)
- Nicotine-containing e-cigarettes (vapes) can be recommended as a first-line treatment, although none are currently licensed for medicinal use by the MHRA
- Stop-smoking interventions are more likely to be successful when combined with behavioural support; the NCSCT’s updated VBA model (VBA+) describes alternatives to referral when stop-smoking services have been decommissioned
- NRT or e-cigarettes can be used for harm reduction in those who are not ready to stop smoking in one go
- Stop-smoking referrals for pregnant women should be opt-out, and carbon monoxide testing should be offered at every antenatal appointment
- Challenge the perceived benefits of smokeless tobacco use while giving culturally appropriate information about the associated health risks
- Never give up asking patients about stopping smoking.
On e-cigarettes in particular, Louise points out that they are “an effective aid for smoking cessation and are now the most popular intervention used by people trying to give up smoking.”
She notes the troubling statistic that around one-third of smokers have never tried an electronic cigarette, many incorrectly believing that vaping is as harmful as smoking.
“More could be done to encourage those who haven’t tried e-cigarettes to give them a chance. An interest in vaping may be the first time a patient has seriously considered an alternative to smoking; it would be disappointing if this opportunity was lost by not giving them information on the relative safety of e-cigarettes compared with tobacco cigarettes.”