Very Brief Advice on Smoking Jim ORorke ASH
Very Brief Advice on Smoking Jim O’Rorke ASH Scotland jororke@ashscotland. org. uk
What is Very Brief Advice about Smoking? “Very Brief Advice on smoking (VBA) is an evidence-based intervention designed to increase quit attempts among patients who smoke. ” ‘Very brief advice’ (VBA) on smoking in family practice: a qualitative evaluation of the tobacco user’s perspective June 2020 • Can take as little as 30 seconds to deliver and no more than two minutes. • Must be factual and accurate and be sensitive to the receiver and their situation.
What are the benefits of VBA? • Speed of delivery. Usually less than 60 seconds. • It’s opportunistic. So requires no planning, just taking the opportunity to pass on some information and if appropriate, advice. • Often it will be a response to something that a service user/patient has said or a question they have asked you. This means that they are much less likely to respond negatively. • It’s delivered in the style of a conversation and is sensitive to the service users/patients personal circumstances and is therefor more likely to be taken on board. • It can strengthen therapeutic relationship by highlighting your listening skills and, by passing on factual and accurate information, help maintain trust and confidence in that relationship.
Quick to Delivering VBA can take just a few seconds. Here is an example: Service User: “See the Chancellor has put fags up again! Maybe I should pack in. ” (laughs) Worker: “Well, if you ever did want to pack in, I can give you information about stopsmoking services in the area. ” Service User: “What! Is there some nearby? ” Worker: “Yeah, they hold sessions in the local health centre. ” That exchange took less than 15 seconds but the worker informed the service user that: 1. He had information that he could give him about stop-smoking services. 2. Where one of the services took place.
Advice and Information So “very brief advice” also includes “very brief information”. What’s the difference? INFORMATION: Information is factual and not based on opinion or one person’s point of view; therefore it is normally something you can rely on. ADVICE: Advice is based on the person’s experience and knowledge. Advice is not always based on information and therefore can be wrong or misguided. It is important to be as accurate as possible when giving advice to service users. In order to be effective therefor it is important that you have some knowledge of the subject. In our example the worker knew where to get written information to pass-on and where the sessions took place.
Some Knowledge. Not An Expert! So, if you are going to offer some VBA on smoking it’s important that you know enough to pass on accurate information and be thoughtful about any advice you give. You don’t need to be an expert! Where can you find good accurate information about smoking and where to get help to quit?
Good Sources of Information Organization Web Address What you can find ASH Scotland https: //www. ashscotland. org. uk/what-we-do/supplyinformation-about-tobacco-and-health/ Briefings, Fast Facts, Statistics, Research, Reports IMPACT Project https: //impact. scot/resources/ Downloadable information, videos, posters about smoking and mental health. ASH England https: //ash. org. uk/category/information-and-resources/ Fact sheets, Briefings, Reports ASH Wales/Cymru https: //ash. wales/research-reports/ Statistics, Reports, Topics NHS Inform https: //www. nhsinform. scot/healthy-living/stoppingsmoking Support to Quit, Addiction evaluation, Free Quit Packs, Stop Smoking Support in your Area National Centre for Smoking Cessation Training https: //www. ncsct. co. uk/ Smoking cessation training. Limited access in Scotland. ASH USA https: //ash. org/programs/resources/ Webinars, Blogs, Statistics, Human Rights Approach Public Health Scotland http: //www. healthscotland. scot/healthtopics/smoking-prevention Smoking Prevention/Cessation, Smoke-free Environments, E-cigarettes Public Health Scotland http: //www. healthscotland. com/documents/312. aspx “How to Stop Smoking and Stay Stopped” Downloadable PDF
Identifying opportunities to pass-on VBA “Change talk” is what you hear when someone makes a statement about changing their behaviour Statement Expressing “I’d love to give up smoking. It’s so expensive!” Desire. Something they would like to do. “I wish I knew somebody who can help me quit. ” Ability. What they can or can’t do “I have to give up smoking, I’m out of breath. ” Reasons. Something they’ve given some thought to. “My GP says my lungs are in bad shape. I need to quit!” Need. Some urgency that they do something. “ 100% I will give up smoking by Christmas. ” Commitment. They’ve thought about it and started to plan.
Sustaining Change Talk Asking questions or using reflections. You feel the service user/patient might want to talk a bit more about their smoking or you need a bit more information in order to pass-on accurate information and/or advice. Type of question/reflection Examples OPEN QUESTION: invite a person to reflect and elaborate, to say what is important to them. You can better understand what the person is feeling, “How do you feel about your smoking? ” “What do you know about stop-smoking support? ” “If you stopped, what would you do with the money you saved? ” CLOSED QUESTION: ask for specific information important to the questioner. “How many cigarettes do you smoke a day? ” “How much do you spend on smoking every week? ” SCALING QUESTION: can give a measure of a person’s motivation. These can also elicit change talk. “Where 0 is “not at all important”, and 10 is “extremely important”, how important is it for you to stop smoking? SIMPLE/STRAIGHT REFLECTION: help people to explore what they really want by relating back to them what you think you heard them say. “I really want to give up smoking this time!” “You're determined to succeed at this” “Yes, but I think I will need some help. ”
Referring On The point of providing very brief advice on smoking is to help smokers think about a healthy-lifestyles behaviour change It’s NOT your job to: • Tell them to stop smoking • Advise them how to stop • Support them through the process of stopping smoking There are highly trained workers who can do this for you
Referring On Quit Your Way Scotland is run by NHS 24 and is staffed by trained advisors who'll be able to give you expert advice. The service can help by: • talking through all the options available • referring to free local NHS services • sending a free Quit Your Way Scotland quit pack • helping plan to stop in a way that suits the individual • offering support and advice when trying to stop • being there when other support services are closed Contact Quit Your Way Scotland advisor on 0800 84 84 84 https: //www. nhsinform. scot/healthy-living/stopping-smoking
Referring On Pharmacy services Your local community pharmacy provides a free stop smoking service. The service is: • local - there’s usually one in every neighbourhood • convenient - you can drop in to pick up your stop smoking medication and access 1 -to-1 support when it suits you, such as during lunch breaks or after work • flexible - you can go at a time that suits you and it doesn't have to be the same time of day each week
Recap • Very Brief Advice on smoking is an evidence-based intervention designed to increase quit attempts among people who smoke • Can be delivered in as little as 30 seconds • You don’t need to be an expert in smoking • It’s opportunistic. You don’t raise the issue of smoking, the service user/patient does • It gives you the chance to pass on information or advice about how and where to get support to stop. Information/advice must be accurate • You use the listening skills you already have and use in your job every day. • It’s not about telling people to stop smoking or you providing the stop smoking support • There is a variety of types of free support available through the NHS and Community Pharmacies including medication and behavioural support.
Thank You Jim O'Rorke jororke@ashscotland. org. uk www. impact. scot www. ashscotland. org. uk Twitter: @jimororke Instagram: impact. scot
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