Brief Advice – Ask, Advise and Help
This information is a short overview of Cancer Council Australia’s Brief Advice model of smoking cessation. For more information about receiving Brief Advice training for your health service, please contact us.
People who smoke generally use the health system more than people who do not smoke. For many people, experiencing an episode of ill-health provides great motivation to make a quit attempt. However, many health practitioners find it difficult to prioritise smoking cessation amongst other competing health needs.
In recognition of the challenges and opportunities of providing smoking cessation support in a clinical setting, the cessation model favoured by Cancer Council Australia is simple, quick and effective.
Smoking cessation support is best provided by health professionals in the form of Brief Advice. In this model, health professionals encourage patients/clients to use a combination of two best-practice treatments:
- Multi-session behavioural intervention (Quitline telephone support).
- Stop smoking medications (including nicotine replacement therapy).
The Brief Advice model is used to motivate people to quit smoking and direct them to the right treatment over the course of a short conversation; it does not expect health professionals to deliver time-intensive multi-session interventions.
Ask, Advise and Help
The Brief Advice model has been designed to be delivered by all health professionals in as little as 3 minutes in just 3 short steps:
1. Ask all patients/clients about their smoking status and document answers in their medical records.
The questions include: “Do you smoke?”, “How do you feel about your smoking at the moment?” and “How much money do you think you spend on the smokes?”.
2. Advise all patients/clients in a tailored and relevant way that the best thing they can do for their health is to quit, and describe how to go about quitting using the following examples.
“Tobacco is expensive. Maybe we should think about how you can reduce and quit smoking so that you can save some money.”
“It seems that you’re out of breath a lot recently. Smoking is known to affect people’s breathing. The best thing you can do today for your breathing is to quit smoking.”
3. Help patients/clients by referring them for a multi-session behavioural intervention (Quitline) and prescribing stop smoking medication (or facilitating access to stop smoking medications) such as nicotine replacement therapy.
“That’s fantastic that you’ve made a decision to quit smoking. I’m going to prescribe you some nicotine replacement therapy to help you manage the cravings you might get. After that, let’s make you a referral for the Quitline, they will support you to make a plan to give up smoking.”
This model of care is appropriate in all areas of the health system and can be used by any health professional.
This short video demonstrates the power that conversations, led by health professionals, can have to influence a patient’s decision to quit smoking.
Brief Advice is appropriate in all areas of the health system and can be used by any health professional.
- Kotz D, Brown J, West R. ‘Real-world’ effectiveness of smoking cessation treatments: a population study. Addiction. 2014;109(3):491-499
- Stead L., Bergson G., Lancaster T. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews. 2008; (2): CD000165
- Alfred Health. Start the Conversation. http://starttheconversation.org.au/
The stories on this site are about real patients and clinicians. They share their experiences about the life-changing conversations that resulted in people quitting smoking.
Behavioural intervention: Referring to Quitline
While pharmacotherapy is integral to treating nicotine dependence, it does not deal with the behavioural and habitual challenges of stopping smoking. For busy health professionals, the Brief Advice model recommends referring onwards.
The Quitline telephone support service provides patients/clients with specialist behavioural interventions over multiple sessions for no charge.
Studies have found that patients referred to the Quitline, in comparison with in-practice management by a GP, were almost twice as likely to be abstinent at three months.
Referrals to Quitline can be made reactively where a patient/client initiates the call to the Quitline themselves, or they can be made proactively where the Quitline initiates contact with a patient/client after a referral from a health practitioner.
Evidence shows that patients who are proactively referred to the Quitline by a health practitioner are 13 times more likely to continue through with the cessation treatment than when a patient calls the Quitline themselves.
Given the efficacy of referral to the Quitline, Cancer Council WA recommends that all patients who smoke and consent to assistance be referred automatically to the Quitline. Under this method, it is up to the patient to refuse the assistance of the Quitline, rather than the patient’s responsibility to initiate the call. This opt-out method is likely to result in far greater uptake of the Quitline.
Making a referral to Quitline
Cancer Council South Australia runs and coordinates the Quitline for WA users.
Making a referral to the Quitline for your patient/client is fairly simple. There are three options:
- Use the online referral form to refer your patient/client to the Quitline.
- Download the Quitline SA digital referral templates for Medical Director, Best Practice or Zedmed
- Call the Quitline with your patient/client to initiate support with a Quitline counsellor directly. The Quitline can be reached on 13 7848. Webchat is also available.
- Vidrane JI, Shete S, Cao Y, Greisinger A, Harmonson P, Sharp B, et al. Ask-Advise-Connect: a new approach to smoking cessation treatment delivery in health care settings. JAMA Internal Medicine. 2013; 173(6);458-64. Epub 2013/02/27
- Borland R, Balmford J, Bishop N, Segan C, Piterman L, McKay-Brown L, et al. In-practice management versus quitline referral for enhancing smoking cessation in general practice: a cluster randomised trial. Family practice. 2008;25(5):382-9
This information is not intended to replace the recommendations of local clinical guidelines and protocols. Health professionals should consult local health authorities or documents before providing clinical advice to patients/clients.
There are two main types of pharmacotherapy available for patients/clients who wish to quit smoking: nicotine replacement therapy (NRT) and other smoking cessation medications.
Nicotine replacement therapy (NRT)
NRT products replace the nicotine ordinarily consumed by smoking. By replacing this nicotine, symptoms of withdrawal are lessened or avoided altogether.
Using NRT can improve successful quit rates by 50-60%, with greater quitting success achieved when NRT products are used in combination. Combination therapy uses a long-acting product (namely, a transdermal nicotine patch) as well as a short-acting product (such as a spray, lozenge, gum or inhalator). When combined, the nicotine patch provides a baseline level of nicotine while a shorter-acting product can be used at intervals to manage acute cravings.
NRT products are unscheduled which means they are available unrestricted at a variety of locations including supermarkets and pharmacies.
Certain NRT products including as patches, gum and lozenges are currently listed on the Pharmaceutical Benefits Scheme (PBS) and can be purchased at reduced cost when prescribed by a medical practitioner under appropriate circumstances. For Aboriginal or Torres Strait Islander Australians, NRT can be attained without cost under the Closing the Gap scheme on the PBS.
Smoking cessation medications
There are also other medications patients/clients can take to assist in smoking cessation. Once appropriately prescribed, these can be taken in combination with NRT.
Varenicline (Champix): This medication is a partial agonist of nicotinic receptors and works by maintaining dopamine levels to attenuate withdrawal symptoms and urges. The drug also limits the rewards of smoking by blocking some receptors of nicotine. Varenicline has been shown to be the most effective pharmacotherapy when compared with NRT and other medications.
Bupropion (Zyban): This smoking cessation drug has been proven to increase the likelihood of sustaining long-term quit attempts.
- Department of Health, Western Australia. Clinical guidelines and procedures for the management of nicotine dependent inpatients. Perth: Smoke Free WA Health Working Party, Health Networks Branch, Department of Health, Western Australia; 2011
- Pharmaceutical Benefits Scheme; nicotine information.
- Royal Australian College of General Practitioners. Supporting Smoking Cessation: A guide for Health Professionals – Nicotine Replacement Therapy. 2011:
- Tobacco in Australia. Pharmacotherapies. In: Scollo, MM and Winstanley, MH Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2018
- Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T. Nicotine replacement therapy versus control for smoking cessation. The Cochrane database of systematic reviews. 2018;5:CD000146.
- Lindson N, Chepkin SC, Ye W, Fanshawe TR, Bullen C, Hartmann-Boyce J. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. The Cochrane database of systematic reviews. 2019;CD013308