Niamh Keating, physiotherapist at Royal Free London NHS Foundation Trust and member of AHPs4PH, explains how small actions from allied health professionals can make a big difference in reducing smoking rates.

Working as a physiotherapist on a vascular ward opened my eyes to the devastating impact of smoking on health and I felt compelled to consider my role in supporting patients to quit. So, I completed e-learning on giving very brief advice (VBA) on smoking and put the training into practice.

I’ve written this blog to share my experience and perspective of routinely offering advice on smoking cessation, in the hope that it may inspire others to adopt it as part of their routine practice.

Allied health professionals (AHPs) have a key role in health promotion and evidence tells us that the public trust the healthy lifestyle advice given to them by AHPs. However, many AHPs do not have conversations about smoking cessation with patients. To provide the best care to our patients, we have a responsibility to support patients to quit, to improve their health and wellbeing.

So why don’t we talk to patients about smoking? For me, it was lack of confidence, lack of resources and perceived lack of time. Others may feel it is not part of their job or that their advice would not be welcome or effective; or maybe that if someone else has already given the advice, there is no point repeating it. Here’s what I've learnt:

• It is not time-consuming at all! It takes a minute or two to have this conversation. Yes, really, I’m not kidding. If you stick to the script and don’t deviate too much, the job is done in a minute!
• The VBA training is a must. The e-learning teaches you a script which is positive, informative, evidence-based and an efficient way to structure your brief conversation. Smokers respond much better to this brief, positive approach than the traditional ‘lecture’ instructing them to quit and warning them of the harms of smoking.  An offer of support is much more helpful, effective and well-received.
• Practice makes perfect. Giving brief advice on smoking cessation is based on the 3As approach; Ask, Advise, Act.  The first couple of times I tried to give brief advice, I kept deviating from the script, asking other questions, none of which were helpful for me or the patient. It just made the conversation longer and more complicated than it needed to be!  Just ask: “Do you smoke?” If the answer is yes then follow it up with advice; “well If you are thinking of quitting, the best way to do it is with medication and specialist support” and then act “ I can refer you to your local Stop smoking service (SSS) today if you want to give it a go?” It is that simple. Let the experts at the Stop Smoking Service ask the detailed questions, your job is to sell the referral!
• AHPs are effective messengers. AHPs are well-placed to give advice on smoking. We develop excellent relationships with patients and the period of ill-health or hospital admission often provides a window of opportunity where the patient may be more motivated to quit. Our quality improvement project on a vascular ward, showed that when AHPs routinely gave brief advice to patients who smoke, 1 in 3 accepted the offer of a referral to their local Stop Smoking Service.
• Repeated health messages can be effective. You may wonder if another health-care professional (HCP) has already given brief advice on smoking then what's the point in repeating it In our project we found that many of the patients referred to Stop Smoking Services by an AHP had previously received advice from another HCP during that admission. In my experience, if delivered in the right way, patients are very receptive to this advice. And even if the patient declines the offer of help, remember the importance of planting that seed, or maybe watering a previously planted seed.

Giving advice on smoking is something that all HCPs can easily build into routine practice. When I first started having conversations on smoking, I felt awkward and unsure but with training and practice I now I do it routinely without thinking about it. I know that it is worthwhile, and still get a buzz when a patient reacts positively by accepting that offer of support. 

Remember, most patients who smoke are addicted and most smokers want to give up, but most struggle to do so alone. Let’s support our patients to quit to improve their health and well-being.

Smoking conversations can take just one minute. Do you have a minute? It could save someone’s life!