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7.10 Cessation interventions as part of prevention and treatment in the healthcare system
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Greenhalgh, EM|Stillman, S|Ford, C. 7.10 Cessation interventions as part of prevention and treatment in the healthcare system. In Greenhalgh, EM|Scollo, MM|Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne : Cancer Council Victoria; 2019. Available from https://www.tobaccoinaustralia.org.au/chapter-7-cessation/7-10-cessation-interventions-in-the-healthcare-system
Last updated: August 2026

7.10 Cessation interventions as part of prevention and treatment in the healthcare system

Cessation interventions should form part of routine care for all types of healthcare professionals, and should be seen as a crucial part of prevention and treatment. This section includes information on the role of:

See Section 7.11.5.2 for a discussion of the role of health professionals in providing cessation care to pregnant women, and Section 9A.3.6 for the role of mental health professionals in promoting quitting among people with mental illness.

Smoking cessation not only reduces a person’s risk of many diseases and improves health in general, it can also increase the effectiveness of treatments, improve recovery from surgery and illness, and improve rates of survival.1 Experiencing health concerns can also be an important motivator for people who smoke to make a quit attempt. Cessation interventions should therefore form part of routine care for all types of healthcare professionals, and should be seen as a crucial part of prevention and treatment.2-5

Interventions delivered by healthcare providers can increase smoking cessation among service users. Even brief, simple advice about quitting increases patients’ rates of successful cessation,6-10 and given that smoking affects almost all parts of the body (see Chapter 3), healthcare providers should integrate brief cessation interventions into routine care. A 2015 review of healthcare interventions concluded that brief advice from a healthcare worker is a globally affordable healthcare intervention to promote and assist smoking cessation.8 Such advice should be provided to all people who smoke, regardless of their interest in quitting.11 Advice from physicians can also affect the attitudes, knowledge, intentions, and quitting behaviours of adolescents, thereby promoting both prevention and cessation.12

Reviews show a small, additional benefit of intensive advice and follow-up visits.6,13 Interventions with more than one component, such as those that combine two or more of the elements of the 5As brief intervention framework (see below) increase quit rates in primary care settings.13 The delivery of smoking cessation intervention by more than one type of health professional has the potential to increase quitting and readiness to quit.14 Some doctors or other health professionals have the opportunity to provide intensive behavioural interventions for people who smoke or to refer them, if appropriate, to specialist services.(See Section 7.10.8.) Specialist services include telephone services, cessation specialists within practices or healthcare centres, group quit courses, and individual counsellors. Referral to specialist services can address some of the common barriers to intervention faced by other healthcare professionals, particularly time constraints. Quitline provides a readily accessible specialist service to which health professionals can refer their patients. (See Section 7.14.1.) Proactive referral (whereby the healthcare professional sends the person’s details to Quitline so that he or she is contacted by a Quitline staff person) leads to substantially higher rates of utilisation than the provision of simple advice to call.15-17

In terms of the efficacy and cost-effectiveness of cessation interventions, the ‘number needed to treat’ (NNT, or the number of people who will successfully quit for every person who receives a cessation intervention) is relatively low. For example, to have one person quit smoking, 23 people need to be treated with NRT, or 10 people with varenicline.18 Figure 7.10.1 compares the NNT to prevent one death among clinical interventions delivered in primary care, and shows that the impact of successful smoking cessation (represented in pink) substantially exceeds that of other common clinical interventions (represented in green).18-20 Additional studies have also demonstrated the cost-effectiveness of cessation interventions in primary healthcare.21

Despite the majority of patients who smoke wanting to quit, health professionals often underutilise opportunities to provide cessation advice,13,22-25 and smoking cessation is neglected in many clinical guidelines.26 Factors positively associated with health professionals providing cessation intervention and counselling include believing that it is part of their role, confidence in providing counselling, knowledge of community cessation resources, and the patient-centeredness of the organisation.23,27 Having a tobacco cessation ‘champion’ within an organisation can also promote the systematic implementation of cessation interventions and positive outcomes.28 Barriers cited by healthcare providers include lack of reimbursement, lack of training, and lack of resources for follow-up.13,29,30 Additional barriers can include low literacy levels of people who smoke, competing demands, and lack of access to products or services.31 Health professionals who are non-smokers are more likely to deliver cessation interventions than those who smoke.32,33 The substantial improvements in treatment outcomes following quitting smoking has led to vigorous debate about the ethics, economics, and health effects of refusing some hospital treatments for patients who continue smoking.34-36

7.10.1 General practitioners (GPs)

In 2024–25, more than 4 in 5 Australians (84%) had consulted a GP at least once in the previous year;37 such contacts provide an excellent opportunity for promoting smoking cessation. GPs are perceived as credible and authoritative on health issues, and their advice as appropriate and acceptable.38,39 A Cochrane review last updated in 2013 concluded that even when doctors merely provide brief, simple advice about quitting, this increases the likelihood a person who smokes will successfully quit and remain a non-smoker 12 months later.6

Time constraints mean that GPs spend only limited time with most people who smoke (i.e. a few minutes), therefore brief interventions are well-suited to form part of routine consultations. Guidelines on cessation published by the Royal Australian College of General Practitioners recommend using the three-step brief intervention model40 (sometimes known as the ABC model: ask, brief advice, cessation support):

  • Ask and record smoking status
  • Advise all people who smoke to quit and on the most effective methods
  • Act/Help by offering to arrange referral, encourage use of behavioural intervention and use of evidence-based smoking cessation pharmacotherapy

More comprehensive support can be provided using the 5As approach:40

  • Ask: identifying all patients who smoke
  • Assess: assessing nicotine dependence and barriers to quitting
  • Advise: advising them to quit
  • Assist: offering quitting assistance
  • Arrange: arranging follow-up.

Receipt of brief interventions is associated with a significant increase in patients' use of counselling and cessation medication,41 and with smoking cessation.42 It is considered best practice in the US,43 UK,44 New Zealand,45 and by the World Health Organization.46

Despite the inclusion of the ABC and 5As in a number of national guidelines, they are not always implemented in practice,13,47,48 or are not implemented in full.49 Failure to implement brief interventions is associated with workload, perceived lack of remuneration, patients’ characteristics, and the smoking status of the GP.33,50,51 A lack of training and confidence can also create feelings of illegitimacy among GPs—particularly early-career GPs52—in relation to their ability to provide cessation interventions, though patients report that they are a legitimate and trusted source of cessation advice.53 Doctors who smoke are less likely than non-smokers or ex-smokers to advise and counsel their patients to quit,50 but can be more likely to refer them to smoking cessation programs.54 An Australian survey of adults who had visited a GP in the past year found that only about half of those who smoked reported receiving advice or motivational support to quit. Those who did receive advice to quit rated the overall quality of care higher.55

Few patients visit their doctor with smoking-related addiction as their main complaint, and brief visits often focus on other problems.56 Many clinics do not have systems in place that routinely include brief cessation interventions, but there is evidence that healthcare settings can increase cessation interventions by building on an existing electronic health record platform.56 An Australian study found that the combined use of self-auditing, feedback, and education can improve GP management of smoking cessation.57 Suggested changes to clinical practice to improve tobacco treatment implementation in clinical settings include portraying proven treatments as best care, being prepared to deliver the appropriate treatment, including tobacco treatment in clinical team workflows, and taking advantage of every opportunity to deliver an intervention.58 The use of computer-based interventions alone or in combination with practitioner-delivered advice can assist the participation of general medical practices in tobacco control.59 Allowing GPs adequate time and payment for smoking cessation consultations may also help to embed tobacco use treatment in routine care. For example, a temporary Medicare Benefits Schedule (MBS) item for nicotine and smoking cessation counselling was introduced in Australia between 2021 and 2023 and claims data showed a substantial increase in face-to-face consultations during this time.60

The Quit Centre provides online training to GPs in best practice cessation care.61 Clinical practice guidelines for smoking cessation intervention also emphasise the utility, efficacy and reach of telephone quitlines.62 An Australian randomised controlled trial found that GPs referring people who smoke to Quitline increased smoking cessation compared with in-practice management.63 Proactive referral—whereby Quitline contacts the patient after receiving his or her details from the doctor—is more effective than simply advising patients to call.15-17 A 2021 Cochrane review concluded that cessation counselling (such as that provided by Quitline), free cessation medications, or tailored written materials may increase cessation rates when provided in addition to standard smoking cessation care in primary care practice.64 Patient-centred approaches may also improve the implementation of cessation interventions. Although patients who smoke who are highly engaged during medical encounters are more likely to respond to cessation advice, even those with low engagement are more likely to try and quit if they receive cessation counselling.65 Improving communication between patients and providers may promote greater engagement. One study that interviewed people who smoke about their cessation experiences found that many reported feeling shame, isolation, or disrespect, and frequently expressed wanting honest, consistent, and pro-active discussions and actions in their interactions with primary care providers.66 Australian studies have also noted that people who smoke can anticipate stigma in healthcare settings and may delay or avoid seeking care when needed.55,67 A review of clinician messaging over time concluded that using gain-framed statements such as "Quitting smoking will benefit your health by preventing problems like lung and other cancers, heart disease, and stroke" is more effective than using loss-framed statements such as "Smoking will harm your health by causing problems like lung and other cancers, heart disease, and stroke."68

7.10.1.1 GP practice nurses

Practice nurses provide additional patient care and support within general practice settings in Australia; however, there is relatively little research on their role in promoting smoking cessation. A randomised controlled trial that was conducted in Sydney and Melbourne evaluated the uptake and effectiveness of tailored smoking cessation support, provided primarily by the practice nurse, and compared it to other forms of cessation support (Quitline referral and usual GP care). Results showed that patients who received more intensive practice nurse intervention were more likely to quit.69 An evaluation of the trial found that it was viewed positively by practice nurses, with most reporting being satisfied with the training and the materials provided.70 Interviews with Australian nurses in GP settings revealed that nurses want to support people in quitting smoking. Nurses cited the ambiguity in their roles in the delivery of smoking cessation care and the emerging issue of vaping as important challenges, highlighting the need for support and clearer guidelines.71 A survey in the UK found positive attitudes among nurses toward providing cessation interventions and highlighted the importance of training in increasing nurses’ enthusiasm about giving cessation advice and perceiving such advice to be effective.72 A systematic review concluded that non-pharmacological community-based nursing interventions (i.e. outside of hospital settings) can effectively change knowledge, beliefs and attitudes among adults who smoke.73

7.10.2 Hospital-based interventions

Smoking places a substantial burden on hospitals, and smoking cessation should be systematically embedded in the healthcare system; hospital admission is an ideal time for the delivery of cessation interventions.74 One review highlights that complex and multi-faceted implementation approaches capable of driving system changes are needed to effectively embed cessation care and change clinician behaviour.74 When such interventions are adopted by hospitals, they can lead to improved patient outcomes and decreased subsequent healthcare usage.75,76

7.10.2.1 Emergency department

The role of emergency department (ED) staff in cessation intervention holds significant potential to encourage quit attempts in patients who smoke.77 However, ED doctors and nurses appear to frequently miss opportunities to offer smoking cessation interventions.78 A multicentre survey of ED providers in the US found that while asking and advising were relatively common, assessing, assisting, and arranging support for patients were low overall.79 ED staff in the US have expressed ambivalence toward the implementation of smoking cessation guidelines. Doctors and nurses agreed that implementing cessation interventions is important, but felt that it is not always practical due to time constraints, the competing demands of acute care, and resistance from patients. They also sought improved role clarity and teamwork when implementing the 5As in the ED.80 New Zealand research found that doctors and nurses in critical care settings held positive attitudes toward and had received training in providing smoking cessation advice, and perceived advising patients to stop smoking as their responsibility. However, patient acuity and level of sickness affected their ability to deliver smoking cessation advice.81

Despite the challenges, interventions in emergency healthcare settings are worthwhile. Cessation interventions in EDs can be effective in prompting quit attempts and ED patients are interested in quitting and in receiving support.77,82-86 A 2014 systematic review concluded that ED visits in combination with ED-initiated tobacco cessation interventions are associated with higher cessation rates,87 and a 2017 systematic review and meta-analysis similarly concluded that ED-initiated cessation interventions are effective in promoting abstinence up to 12 months after intervention.88 A 2026 meta-analysis found that cessation interventions delivered in EDs that included NRT were associated with increased likelihood of smoking cessation.89 Intensive intervention can also improve tobacco abstinence rates in low-income people in the ED.90 A study across two Melbourne hospitals found that while smoking was more prevalent than among the general population, more than one-third of ED patients reported wanting to quit, and almost two-thirds were willing to receive a brief intervention. Face-to-face individual or group counselling was preferred over telephone counselling or a session with a doctor.91

7.10.2.2 In-patient care

The prevalence of smoking is relatively high among people admitted to hospital, with an Australian and New Zealand study finding that one in five ICU patients currently smoked.92 Both patients and staff report that hospitalisation is an appropriate time to address smoking, so it represents an important opportunity to promote cessation.93 A 2024 Cochrane review concluded that offering hospitalised patients smoking cessation counselling beginning in hospital and continuing for over one month after discharge increases quit rates compared with no counselling. Starting nicotine replacement or varenicline in hospitalised patients also promotes cessation.94 A randomised controlled trial across five Australian public hospitals examined the effectiveness of combining varenicline with NRT lozenges for smoking cessation in hospitalised adults. Self-reported abstinence was higher in the group that received this combination compared with varenicline alone.95 A systematic review and meta-analysis examined the effectiveness of NRT in critically ill people who smoke who were admitted to the intensive care unit (ICU). Findings showed that those who received NRT had a shorter ICU stay by an average of three days, however there were no improvements in other outcomes (durations of delirium, mechanical ventilation, or vasopressor use).96 Combining behavioural support with cessation pharmacotherapies is likely to further increase cessation rates among people who smoke who are admitted to hospital,94,97-99 though several studies have noted that NRT should not be routinely provided in the ICU setting.100-102

Despite increases over time in the provision of cessation interventions to hospitalised patients, they are still underutilised.103 It may be possible to increase hospital smoking cessation delivery, particularly the provision of NRT, by using a multi-strategic intervention including education of health professionals.104,105 Making such interventions a routine part of hospital care could dramatically increase the number of smokers offered smoking cessation support.106 In 2015, a framework for hospital-based intervention was proposed following the NSW Health Smoke-free Health Care Policy, which stipulated that all clinical staff must provide routine brief interventions for all smoking patients. It suggests that: hospitalisation is a powerful teachable moment; all patients should be asked about smoking on admission, and people who smoke should be encouraged and assisted to quit permanently; the most effective interventions include a combination of counselling and NRT; and patients should be followed-up for at least 4 weeks after discharge.107 In Queensland, the state-wide Smoking Cessation Clinical Pathway (SCCP) brief intervention tool was implemented in 2015 and is used by clinical staff in public hospitals to promote cessation among in-patients. Research has shown that this approach appears to increases the provision of cessation interventions and NRT, and can promote both short- and long-term cessation.108

In Australia, all states and territories except Victoria have Medicine Formularies, which are approved lists of medications that public hospital pharmacies should have in stock. NR can help patients admitted to hospitals to comply with smokefree policies and to attempt to quit completely. Smoking is known to reduce the effectiveness of numerous surgical and pharmaceutical treatments—see Section 3.15. Formularies can assist in standardising prescribing and improving equity of access as they help patients to receive consistent treatment regardless of which hospital they attend—treatment which should ideally align with best practice evidence and guidelines. Australian jurisdictions vary in the smoking cessation medicines on their Formularies (see Table 7.10.1), but several include both NRT and varenicline. The Victorian Government is currently developing the Victorian Medicines Formulary,109 and the inclusion of first-line cessation medications could help provide more equitable access to evidence-based, effective treatments for tobacco dependence. A recent US study has found that prescription of cessation medications in hospital can reduce the risk of rehospitalisation among people who smoke, and that low prescription rates represent a significant gap in care.110

Nurses are the largest healthcare workforce and are involved in nearly all levels of hospital care. Guidelines for clinical care in some countries recommend that every nurse should consult their patients about smoking,111 and the first recommendation in the position statement of the International Society of Nurses in Cancer Care states that nurses must be recognised as and empowered to be critical enablers in the fight against the global tobacco epidemic.112 Nurses can be effective in delivering tobacco cessation interventions, particularly when they receive cessation training and have positive attitudes and high self-efficacy for delivering cessation support,113 but some lack appropriate knowledge and/or skill.114 A survey of Australian nursing students found that most felt they lacked specific knowledge to help patients quit.115 A review of smoking cessation training in undergraduate nursing students found that it positively impacted knowledge, attitudes/motivation and self-efficacy.116 Nurses who smoke appear less likely to deliver cessation interventions.113 A 2017 Cochrane review found moderate quality evidence that advice and support from nurses could increase people's success in quitting smoking, whether in hospitals or in community settings.117 Additional reviews have  similarly supported the effectiveness of nurses in promoting smoking cessation,118-121 with one finding particular benefit of this approach combined with NRT.122 Hospital pharmacists may also be well-placed to deliver cessation interventions to in-patients.123

7.10.2.3 Surgical care

Smoking causes a range of adverse surgical outcomes.124 (See Section 3.15.1) Although longer cessation is ideal,125 even short-term smoking cessation prior to surgery may help reduce the risk of postoperative complications,126-130 with several reviews suggesting cessation at least 3–4 weeks prior to surgery.131,132 An overview of systematic reviews found that interventions starting at least 4 weeks before surgery and including multiple behavioural support sessions and pharmacotherapy reduced postoperative complications, particularly surgical site infections. Shorter interventions or those with only one component increased cessation rates but did not reduce complications.133 The Australian and New Zealand College of Anaesthetists recommend that anaesthetists and surgeons should not be dissuaded from advising patients to quit at any time before surgery.134 Preoperative smoking cessation interventions are also cost-effective.135

Patients facing surgery are interested in quitting and believe their physicians have an important role in their cessation attempts.136,137 People who smoke may benefit from an intensive cessation program one month before surgery, and it may help long-term cessation.138-141 However, patients are not always well informed about the immediate benefits of quitting to their surgery outcomes.136 An Australian survey of adults undergoing non-emergency surgery found that most did not think that smoking might cause a problem with their surgery or anaesthetic, and almost half did not receive advice to stop smoking. When cessation advice was provided it was associated with a quit attempt, especially when a surgeon gave advice.142 One study of anaesthesiologists and their patients found significant discrepancies between reports of provision of smoking cessation counselling; three quarters of anaesthesiologists stated that they frequently or almost always advised patients about the health risks of smoking, but patient surveys showed that less than one third received advice about the health risks of smoking, and less than one quarter received advice to quit before surgery.143 Research in the US found that, compared with non-surgical residents, surgical residents were less likely to perform cessation counselling and more likely to think that counselling was not part of their job. Both groups frequently missed opportunities to help patients quit. Surgical residents were also more likely to cite a lack of time and formal training as barriers to implementing interventions.144

Barriers to cessation intervention in surgical care include perceived lack of time for training and intervention and lack of knowledge about referral options, such as quitline services.136 Clinicians also report lack of organisational support, perceived patient objection, lack of systems to identify smokers, perceived inability to change care practices, perceived lack of efficacy of interventions, and the cost of providing care as barriers.145 Patients may not have enough pre-operative contact with the hospital to maximise smoking cessation intervention.146 Australian research has found similar barriers, but also notes facilitators of cessation care including optimism and empathy among individual clinicians, as well as strong teamwork.147

A number of studies have examined ways to increase the effectiveness of cessation interventions prior to surgery. A 2014 Cochrane review concluded that preoperative smoking interventions providing behavioural support and offering NRT increase short-term smoking cessation and may reduce postoperative morbidity.148 Additional systematic reviews and meta-analyses have also supported the effectiveness of preoperative cessation interventions for increasing quit rates and for potentially reducing complications from surgery,149-152 with several noting greater effectiveness or reduced complications only among patients who received more compared with less intensive interventions.150,153,154 For example, a 2017 systematic review examined the components of effective cessation interventions for surgical patients. It found that overall, interventions almost doubled the proportion of people who smoke who were abstinent or reduced smoking by surgery relative compared with control (46.2% vs. 24.5%). Components of more effective interventions included a greater number of sessions, face-to-face delivery by nurses, and certain behaviour change techniques.155

Australian researchers found that even a simple preoperative intervention was effective in promoting smoking reduction or cessation up to one year post-surgery,156 and another Australian trial noted good uptake of uptake of free mailed NRT and Quitline support among patients on the waiting list for surgery, and this was associated with greater quit attempts and success.157 A study of patients undergoing spinal surgery who had recently quit smoking also found that high dose nicotine patches reduced postoperative pain and opioid requirements, as nicotine withdrawal can affect pain levels and management.158 One review notes that many studies looking at the effects of preoperative cessation have recruited people who smoke very close to their scheduled surgery, therefore the benefits of preoperative smoking cessation may have not been fully apparent.159  Another concludes that while many interventions show promising outcomes, there is wide variability in interventions in type, setting, timing, duration, modality, and intensity, highlighting the importance of ongoing research to establish best practice.160

7.10.2.4 Outpatient care

Outpatient settings offer important opportunities to provide cessation intervention and relapse prevention to people who smoke, but are underutilised.161 This is despite the fact that referral to evidence-based tobacco treatment after hospital visits is effective.162 Smoking cessation interventions by nurses are beneficial for non-hospitalised patients,163 and cessation programs combined with routine rehabilitation and care for outpatients are also effective in promoting abstinence.164,165

7.10.3 Pharmacists

Community pharmacies may be an underused resource for helping to deliver public health services.166 Pharmacies supply cessation products to a large number of people trying to quit smoking, which creates opportunities for providing sound advice and support. Pharmacies have potential as health promotion agencies as they are the most accessible healthcare services in the community and are visited by both healthy and sick people.167 The Pharmaceutical Society of Australia’s guidelines for nicotine dependence support168 recommend that pharmacists should offer brief advice to all people who smoke or vape.

A number of studies and reviews suggest that trained community pharmacists can deliver smoking cessation interventions that are effective in helping people who smoke to quit.166,169-173,174-177 A 2019 Cochrane review found low-quality evidence that community pharmacists can provide effective behavioural support to people trying to quit. Findings suggested that more intensive interventions beginning prior to the quit day and comprising weekly appointments increased effectiveness.178 A small trial in Tasmania supported the provision of free NRT to priority populations through community pharmacies, which may help to remove financial barriers to quitting.179

People who smoke report perceiving pharmacist-assisted cessation to be an appealing approach to quitting.180 Australian research that explored the knowledge and practices of community pharmacists found that while their cessation counselling was satisfactory, further education is needed to improve practice standards in terms of matching a patient's history and smoking status to an appropriate product.181

While specialist-led group services appear to have higher quit rates than one-to-one services provided by pharmacies, pharmacy services treat many more people who smoke and both are cost-effective.182,183 An economic analysis of providing cessation counselling training to physicians and pharmacists found that synergistic educational training for both groups could be a cost-effective method for smoking cessation in the community.184 Several additional trials have similarly found that pharmacist-delivered cessation interventions are effective and cost-effective.177,185

Pharmacists report a number of common barriers to providing cessation intervention, including fear of negative reaction from customers, their perception of a customer’s unwillingness to discuss smoking, the short length of the relationship with the customer, perceived lack of demand, and lack of confidence by the pharmacist.186,187 Education and routine training for all pharmacy personnel may increase the implementation and success rates of pharmacy-led smoking cessation services.175,188,189

7.10.4 Dentists

Smoking is a significant contributor to oral disease and cancer, and cessation is an important part of the treatment of periodontal diseases190 and improvements in periodontal health.191 A review of international evidence concluded that behavioural intervention for smoking cessation involving oral health professionals is effective in reducing tobacco use in smokers and users of smokeless tobacco and preventing uptake in non-smokers.192 A 2021 Cochrane review found very low‐certainty evidence that behavioural interventions delivered by dental professionals can increase quit rates. The evidence was stronger when behavioural interventions were combined with NRT.193 Subsequent studies have also supported the effectiveness of cessation interventions in dental settings.194 Dental patients have reported being receptive to dental practitioners inquiring about smoking behaviour and offering advice on quitting.195-197

In Australia, dentists provide care to many high-risk populations, therefore effective training in and the implementation of cessation interventions is essential.198 Tobacco use prevention and cessation guidelines have been developed for dental settings. They involve a level-of-care model based on the 5As,199 with brief intervention, motivational interviewing, and more intensive plans involving pharmacotherapy.200-202 Brief behavioural interventions complemented by pharmacological treatment—with the participation of the entire dental team—are effective cessation interventions within dentistry.193,203 Behavioural interventions that increase motivation and teach regulatory skills (such as coping strategies to avoid relapse) appear to be the most effective within dental settings.204 However, implementation of cessation interventions is poor.201,205-208 The most frequently delivered components of the 5As are ‘asking’, ‘advising’ and ‘assessing’, with ‘assisting’ and ‘arranging’ being less common.202 A large survey of dentists in the US found that almost all reported that they routinely ask patients about tobacco use, about three-quarters provide cessation counselling, and just under half routinely offer cessation assistance (such as referring on or writing a prescription).209

Barriers to providing cessation interventions in dental settings include lack of time, financial considerations, concern about a patient’s interest and resistance, fear of losing patients, too little training, perceived lack of relevance and experience, lack of knowledge about where to refer the patient for further support, and forgetting.190,197,198,210-216 Dental professionals who smoke are also less likely to provide cessation interventions.217 Willingness to intervene is related to periodontal treatment and the presence of smoking-related disease.211 Some research does reveal a lack of adequate knowledge among dental school faculty, staff and students on the negative health effects associated with smoking and a lack of confidence in addressing smoking behaviour.218,219 Further research is needed to better understand and influence the factors that hinder guideline implementation.201,205,220-222

Dental hygienists see their patients regularly, which provides opportunities for cessation assistance.190 However, recommended smoking cessation interventions are not always implemented, with hygienists reporting lack of comfort and confidence in addressing smoking with their patients.223,224 A survey of Australian oral health practitioners found that while the majority of practitioners frequently screened for smoking behaviour, only about half assisted patients to quit smoking. They reported that lack of knowledge of pharmacological treatments and lack of access to smoking cessation resources are common barriers to providing cessation assistance.225 Intervention within paediatric dental practices could help prevent initiation and increase cessation among young people, however several studies have highlighted low adherence by healthcare providers to recommended screening and prevention interventions for children and adolescents.161,226

Measures to promote the involvement of dental professionals in smoking prevention and cessation include increased education on the effects of smoking on oral health, brief intervention training, structured advice protocols, and encouraging greater involvement by dentists, dental nurses and hygienists with patients without acute oral complaints.211,227 Dentists are willing to receive training on smoking cessation interventions, and including training in academic dental and professional development programs increases the use of smoking cessation practices within the dental team.210,228 Dental students generally agree that tobacco cessation counselling is within the responsibility of the dental profession, is within the scope of dental practice, and can be effective.214,229

7.10.5 Interventions for people with serious health conditions

7.10.5.1 Paediatric settings

Paediatricians have the opportunity to deliver cessation interventions to parents that can reduce children’s exposure to secondhand smoke and reduce the risk of a range of acute and chronic childhood conditions. However, screening is often inconsistent and there is a need for standardised processes to document secondhand smoke exposure.230 A systematic review found that physician-delivered training in a brief intervention using CEASE principles (Ask, Assist, Refer) may increase smoking cessation counselling, and training in a CEASE course delivered online or a short intervention using the 5As may increase screening in the paediatric setting.7 A meta-analysis of cessation interventions tailored to parents concluded that they are modestly effective, with parents in the intervention conditions about 1.6 times more likely to quit than parents in the control conditions.231 The role of nurses in paediatric settings also offers promise for promoting cessation among parents, however research in Victoria found that this is not a standard part of care.232

7.10.5.2 Cardiovascular disease

There are enormous health benefits of smoking cessation for patients with cardiovascular disease; quitting smoking is the single greatest lifestyle change people with cardiovascular disease can make to reduce their morbidity and mortality risk. Smoking cessation is recommended to reduce overall cardiovascular risk,233 and US data suggest that smoking cessation is more cost-effective than other preventive cardiology measures.234 However, many people continue to smoke, even after experiencing a major cardiac event.235,236 While many people hospitalised with CVD report being prepared to quit smoking, they often do not use effective methods237 and treatments are underutilised.238 Australian research showed that very few people who smoke who were hospitalised for major cardiovascular disease received prescription cessation medications post-discharge.239 There is also high underreporting of smoking status among cardiac patients who participate in smoking cessation programs.240

Australian guidelines recommend that advice on smoking, nutrition, alcohol, physical activity and body weight should be part of routine management of hypertension for all patients, regardless of drug therapy. However, cardiac health professionals, including lipidologists and cardiologists, could implement more effective smoking cessation interventions.241,242-243 Cardiologists do not always consider themselves the most appropriate person for intervention, but many do not refer smoking patients to cessation specialists or teams for assistance, either.243 Reasons for cessation being overlooked may include that the advent of effective high-tech interventions for cardiovascular diseases has drawn attention away from secondary prevention. Some professionals cite a lack of time or lack of training in smoking cessation counselling.234 Cardiac rehabilitation health professionals report finding it difficult to work with people who smoke, partly because some patients deny the dangers of smoking or are reluctant to discuss their smoking because of the stigma attached to smoking after a cardiac event. Such professionals also report feelings of frustration, failure, and lack of confidence in managing this health issue.244 Nonetheless, interventions are effective at promoting short- and long-term cessation among cardiopulmonary patients.245

The use of pharmacotherapies for smoking cessation is safe and effective for people with cardiovascular disease.246-248 Findings from reviews have varied regarding which medication is superior, however varenicline, bupropion and combination NRT appear to be effective among people with cardiovascular disease, with optimal treatment comprising behavioural interventions combined with pharmacotherapies.247,249-253 The use of cytisine also appears promising, and despite its relatively low use, the Quitline is also effective.254 Another review highlighted the importance of a systematic approach with focus on the 5A's (Ask, Advise, Assess, Assist, and Arrange), as well as the efficacy of pharmacotherapies, NRT, and counselling for smoking cessation in patients with vascular disease.255 A Cochrane review of psychosocial interventions for smoking cessation in patients with coronary heart disease concluded that such interventions are effective in promoting long-term abstinence, as long as they are sufficiently intensive.235

Providing intensive smoking cessation programs for patients hospitalised for CVD increases abstinence,256 and several studies have supported the role of motivational interviewing as a component of treatment.257,258 In the UK, a nurse-led preventive cardiology program in high CVD risk smokers using optional varenicline substantially increased smoking abstinence over 16 weeks and also reduced overall cardiovascular risk compared with usual care,259 and a study in Sweden similarly found that following a heart attack, routine cessation treatment that included cessation consultation with nurses at admission, NRT and varenicline prescription, and contact post-discharge increased successful quitting.260

7.10.5.3 Cancer

A diagnosis of cancer, even a cancer not strongly related to smoking and with a relatively good prognosis, may be associated with increased quitting.261 Motivation and interest in smoking cessation appear to greatly increase following cancer diagnosis, therefore this could be an effective time for encouraging and supporting quitting.262-264 Quitting smoking may also reduce a person’s fear of cancer recurrence.265 However, many patients and family members continue to smoke following cancer diagnosis, and feelings of guilt can lead to the concealment of smoking status from health care professionals.266 Continued tobacco use limits the effectiveness of major cancer treatments and increases the risk of complications and of developing secondary cancers.267 Many patients who initially make a quit attempt at the time of diagnosis also relapse, highlighting the importance of interventions that promote sustained cessation268,269 and that are tailored for cancer survivors.270

Oncology professionals have a crucial role to play in promoting cessation among people with cancer; smoking not only causes cancer, but also reduces the effectiveness of treatment and increases the risk of recurrence and death.1 Cessation improves cancer patients’ prognosis (see Section 3.15.4) and smoking cessation care should be provided at all stages of treatment regardless of the type of cancer.271-273 However, a lack of time, knowledge, skills or confidence can impede the provision of cessation interventions. Oncology professionals can worry that addressing cessation will create feelings of worry or guilt and harm their relationship with patients, particularly if the cancer is smoking-related. Training in communication skills and the delivery of interventions in an empathic and non-judgemental manner can help overcome these concerns.274 Studies have shown that professional organisations can help to promote cessation care,275 and that having a team member specifically trained in tobacco treatment can also increase cessation in oncology settings.276,277 Australian research found that while more than nine in ten medical oncologists and radiation oncologists asked about and documented tobacco use, most felt that cessation should be managed by other professionals, highlighting the importance of collaboration and referral pathways.278 Additional Australian studies have found that only about half or fewer multidisciplinary cancer care clinicians provide cessation interventions. The authors emphasise the need for clinician training, particularly in the use of pharmacotherapies, and systems-level changes that embed cessation as part of cancer care.279,280 One study also notes the importance of providing smoking cessation care to oncology patients who have recently quit, to help prevent relapse.271,281 The provision of cessation counselling during routine cancer screenings may also be a worthwhile strategy282 (see also Section 7.21).

A systematic review of implementation strategies used to integrate smoking cessation in oncology settings found that stakeholder training, evaluative and iterative strategies, interactive assistance (i.e. supervision, facilitation, and technical assistance), clinician support and developing stakeholder interrelationships were associated with increased delivery of the 3As cessation model (Ask, Advise, and Act).283 In Australia, efforts have been made to increase the number of people who smoke who are identified and advised to quit upon diagnoses, including improved electronic record systems, training to clinical staff, and shifting to an opt-out rather than opt-in direct electronic referral system to Quitline and GPs.284,285 Work is also underway to extend this program to all hospitalised patients. Interventions delivered remotely appear to be helpful for smoking cessation among cancer survivors.286

A number of systematic reviews and meta-analyses have concluded that interventions combining behavioural support with pharmacological interventions increase smoking cessation among people with cancer.287-293 A recent review of RCTs additionally noted that the provision of free medication was associated with a greater likelihood of quitting,289 and one found that longer compared with shorted interventions appeared to be more effective among people recently diagnosed.294  Varenicline appears to be safe and effective for people with cancer,295 and bupropion may have specific advantages for cancer patients, including low risk for nausea.296 The US National Comprehensive Cancer Network clinical practice guidelines recommend that treatment plans for all people who smoke with cancer include evidence-based pharmacotherapy, behaviour therapy, and close follow-up with retreatment, as needed.297

Smoking causes most cases of lung cancer, and adversely impacts prognosis once lung cancer is diagnosed (see Chapter 3, Section 3.4). However, many people who smoke with lung cancer continue to smoke post-diagnosis, or fail to maintain abstinence following quit attempts. Several reviews have aimed to examine smoking cessation interventions for people diagnosed with lung cancer, which represents an important factor in improving their prognosis; however they have found no randomised controlled trials that met selection criteria, therefore the efficacy of cessation interventions could not be evaluated.298,299 Limited research suggests that smoking cessation strategies for lung cancer patients should include counselling and use of pharmacological treatment (nicotine replacement therapy, bupropion and varenicline).300 Screening programs for lung cancer also benefit from the inclusion of cessation interventions (see Section 7.21).301

In general, because each patient with cancer has unique medical, psychological, and social circumstances, cessation treatment needs to be individualised.302,303 Patient age, gender and type of cancer may be important factors to consider when developing and implementing smoking cessation interventions for cancer patients.

7.10.5.4 Respiratory diseases

Smoking cessation is the most effective measure for controlling the progression of chronic obstructive pulmonary disease (COPD).300 COPD patients express motivation to quit and often make multiple quit attempts; however, poor mental health, patient misinformation about the health risks of smoking, perceived stigma, low levels of motivation, and poor communication with health professionals can act as barriers to quitting.304,305,306

A 2016 Cochrane review concluded that there is high-quality evidence that smokers with COPD who receive a combination of high-intensity behavioural support and medication are more than twice as likely to quit as those who receive behavioural support alone.307 Subsequent reviews have similarly supported the effectiveness of combination cessation interventions for people with COPD,308 particularly those that are longer in duration and intensive.309  First-line drugs licensed to aid smoking cessation (nicotine replacement therapy, bupropion, and varenicline) are effective in patients with COPD,310 with one review concluding that varenicline and combined NRT (patch and gum) were the most effective pharmacological interventions311 and another finding that varenicline alone and cognitive behavioural therapy (CBT) combined with bupropion increased cessation.308 More intensive and/or extended use of pharmacotherapies may help improve cessation outcomes; for example, combination NRT, higher than usual dosing, or extended use of NRT or varenicline prior to quitting and extended use post-quitting.300,312 A meta-analysis of behaviour change techniques in cessation interventions for people with COPD concluded that such interventions appear to benefit from focusing on forming detailed plans and self-monitoring.313 Proactive referrals to cessation support, such as smoking cessation clinics314,315 and opt-out referrals to Quitline,309 can help ensure patients are connected with evidence-based behavioural interventions. Behavioural interventions offered via mobile phones (mHealth) also appear promising for patients with COPD.316

The prevalence of smoking among people with tuberculosis (TB) is higher than in the general population, and smoking leads to worse TB outcomes. Smoking cessation strategies for TB patients include a combination of counselling and pharmacological treatment (nicotine replacement therapy, bupropion and varenicline).300 One RCT found that use of NRT led to reduction of smoking but not complete cessation,317 and another did not find any benefit of adding cytisine to behavioural support for people who smoke with TB.318 A randomised trial in India supported the use of bupropion for smoking cessation among TB patients.319 Brief interventions320 and motivational interviewing also appear to increase self-efficacy and/or abstinence rates among tuberculosis patients,321,322 and the use of mobile phone interventions (mHealth) also show promise.323

Smoking has detrimental effects on asthma,300 and many people with asthma report wanting to quit smoking.324 Counselling and use of pharmacological treatments is a good approach for smoking cessation in asthma patients; however, there is a lack of smoking cessation trials in this patient population.300 Further research is warranted in this area.262

7.10.5.5 Diabetes

People with diabetes who quit smoking have a lower risk of death and cardiovascular events compared with those who continue to smoke.325 However, research has shown while quitting generally decreases the risk of diabetes overall, smoking cessation is associated with an increased risk and deterioration in blood glucose control in the first 2–3 years of abstinence.326,327 Another review similarly found that cessation can cause weight gain and can be associated with diabetes or obesity onset.328 Therefore, it is important that quit attempts are accompanied by preparation, extra care, and careful monitoring to keep the person’s blood glucose well controlled during this time.326,329 Additional challenges to achieving abstinence for people with diabetes include early uptake of smoking, difficulty with weight management, negative affect, and low motivation for quitting at the time of hospitalisation.262 Lower education level is also associated with smoking in young people with diabetes.330

There is limited evidence to inform treatment strategies for smoking cessation in type 2 diabetes. Two reviews published ten years apart found limited evidence of efficacy for cessation interventions for people with diabetes, though the more recent one supported the use of intensive interventions comprising three to four sessions, lasting at least 20 minutes each.331,332 Another review similarly supported the greater effectiveness of intensive interventions,333 with a number of recent RCTs not supporting the use of brief interventions for this group.334,335 A review of randomized, placebo-controlled studies of varenicline in people who smoke with diabetes concluded that it was an effective and well-tolerated aid for smoking cessation, and safety was comparable with participants without diabetes,336 and another RCT251 and review also supported the efficacy of varenicline for smoking cessation among people with diabetes.337 Bupropion should be used with great caution among people with diabetes, as the risk of seizures is greater in individuals taking insulin or oral diabetes medication.338 Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a treatment for diabetes, and early evidence shows that these drugs may be a helpful treatment for comorbid diabetes and tobacco dependence, as they may help to reduce cravings and improve smoking cessation339 (see Section 7.16.6).

7.10.5.6 HIV/AIDS

Adults living with HIV are more likely to smoke and less likely to quit than the rest of the population.340,341 A long-running cross-sectional study of Australians living with HIV found that 15.5% smoked daily in 2021–22. Encouragingly, this was a substantial decrease from over 50% reporting daily smoking in the early 2000s.342 HIV infection appears to confer an increased susceptibility to the harmful effects of smoking,343 including non-AIDS-defining cancers, cardiovascular disease, and pulmonary disease.344 Smoking also adversely affects the health-related quality of life of people living with HIV/AIDS.344 Cessation may result in better disease management and increased length of survival.344 Many people living with HIV who smoke report being interested in or considering quitting.345 Diagnosis of HIV may be an effective time for intervention.344

Smoking and quitting among people with HIV is influenced by a complex range of social, economic, psychiatric, and medical factors.344,346,347 For example, unemployment, low levels of education, and use of other drugs and alcohol are more common among people living with HIV who smoke.348-350 Some participants living with HIV in an Australian study reported that perceived benefits of smoking (e.g. pleasure, social factors) meant they were unwilling to quit.351 Among those who successfully quit, studies have found associations with older age, use of NRT, and use of antiretroviral therapy.348,352 Surveys in the US found that people with HIV cite cost and a belief that they can quit unassisted as the main reasons for not using pharmacotherapy. Physician assistance was the strongest correlate of prior use. Willingness to use pharmacotherapy was associated with perceived benefits and self-efficacy.353 Self-efficacy plays an important role in outcomes of smoking cessation interventions 354 and cessation medication adherence,355 and measures aimed at increasing self-efficacy to abstain may enhance the effect of targeted tobacco treatment strategies.356 Social support can also promote NRT use adherence.357

Limited evidence shows that interventions for this group are potentially effective, can significantly decrease smoking rates, and can be incorporated within HIV clinics.262,344,346,358-360 Given their regular visits to healthcare providers, clinic-based interventions appear particularly promising among people living with HIV.361 A review published in 2013 found that smoking cessation rates ranged from 6% to 50% across studies employing pharmacologic and behavioural approaches. However, the studies were often small and the effect was often not sustained over time. Smoking was associated with emotional distress, which may be a barrier to successful cessation. Declining adherence to pharmacologic therapy also may have contributed to low cessation rates.345

Several more recent reviews and meta-analyses have supported the efficacy of behavioural interventions for smoking cessation among people living with HIV,362-364 for example text messaging, telephone counselling, and cessation websites.364 However, a 2024 Cochrane review concluded that there was no clear evidence for the effectiveness of behavioural support for quitting smoking among people living with HIV. The review did however support the use of varenicline among this group.365 Several RCTs have supported effectiveness of varenicline for increasing cessation among people living with HIV/AIDS.366,367 Contingency management (rewards for abstinence),368,369 interventions to improve treatment adherence,370 and integration with treatment for depression/anxiety371 may also be helpful adjuncts to treatment.347,372

While health professionals working with patients living with HIV/AIDS agree on the importance of smoking cessation, they sometimes fail to implement interventions.373 A survey of Australian health practitioners found that most reported implementing at least one of the ‘5As’, but only about 3 in 5 (62%) practiced all 5. Knowledge and availability of resources were cited as common barriers, while training in smoking cessation appeared to facilitate addressing smoking.374 Healthcare professionals should actively pursue smoking cessation as a major objective in the clinical care of people with HIV;375 for example, by proactive referrals to Quitline.376

7.10.5.7 Other conditions

Other relevant settings (i.e., specialties that see patients directly affected by or at risk for tobacco-related diseases) where there may be a need and potential for brief cessation interventions to be more fully integrated in routine practice include urological practice,377,378 gastroenterology practice,379 rheumatological practice,380 pulmonology practice,381 gynaecological practice,382 perioperative care (such as by anaesthetists),383,384 periodontal practice,385 plastic and reconstructive surgery386 and paediatric medical practices.387,388 Many of the findings stress the need for further research to highlight and address clinical barriers to providing cessation interventions and training to enhance specialists’ knowledge, skills, and confidence. Smoking is also a risk factor for multiple sclerosis (MS) and researchers have begun exploring the needs of people who smoke with MS389 and developing tailored interventions;390 for example, evidence-based education materials.391

7.10.6 Allied health professionals

There is limited research exploring the effectiveness of smoking cessation interventions in other health professional practices, although some studies have highlighted interest in, and opportunities for increased and improved involvement by many healthcare providers. One small study within podiatrist consultations, for example, showed that providing routine advice to people who smoke could be significantly increased within existing budgets and without prolonging consultations.392

Smoking cessation interventions delivered by optometrists are important, given the relationship between smoking and eye diseases. Evidence suggests that optometrists provide limited cessation support for patients, with barriers to more active involvement being similar to other health professions.393,394 An Australian survey of optometrists found that fewer than half reported routinely asking their patients about smoking status, with younger practitioners least likely to enquire about patients' smoking behaviours.395 However, Australians who visit the optometrist report being receptive to discussions about tobacco use.396

Cessation as a goal in physiotherapy practices is consistent with the profession’s aims to promote health and wellness,397 and smoking cessation advice can be readily integrated into physical therapy practice.397 Studies have found that lack of resources, knowledge and time are the main barriers to providing such advice, and suggest that physiotherapists’ preparedness and confidence in providing smoking cessation assistance need to be increased.398,399 Australian researchers suggest that a three-step brief intervention model—Ask, Advise and Help—can overcome these barriers in physiotherapy practice.400

Quitting smoking is associated with improvements in mental health among people with psychiatric disorders.401 Mental health professionals therefore play an important part in supporting smoking cessation. Integrating evidence-treatment for tobacco use disorder into other ongoing treatments represents an important opportunity for increasing cessation, particularly among people with serious mental illness and/or substance use disorders (see Section 9A.3).402 Similarly, social workers often work with disadvantaged and vulnerable groups that have much higher smoking prevalence, who may particularly benefit from the inclusion of cessation assistance into usual care.403

7.10.7 Interventions for people with disabilities

Studies consistently show that smoking among people with disabilities is higher than among those without disabilities.404 Risk factors for smoking such as lower socioeconomic status and comorbid mental illnesses are more common among Australians with disabilities, who also face unique barriers to accessing cessation aids and physicians’ prioritisation of other health conditions. Researchers have called for greater engagement with the community services sector tailored and targeted cessation services, programs and policies.405

There is scarce research examining cessation interventions for people who smoke who are hearing or sight impaired. Access to smoking cessation programs for those who are deaf is limited due to cultural, linguistic and geographic barriers. Internet-based interventions may provide greater access to cessation assistance, but research is very limited. One pilot study of an interactive website has been positively evaluated by deaf community members.406

Similarly, little is known about the smoking rates of adults with intellectual disability or about effective interventions for this population. UK data suggest that those not using disability services are more likely to smoke.407 Limited research supports the use of mindfulness-based cessation programs.408,409 A systematic review concluded that the body of evidence on the feasibility, appropriateness, meaningfulness, and effectiveness of tobacco-related interventions for people with intellectual disability is small, and the evidence that does exist is of poor/moderate quality. The strongest study developed materials that educated people with intellectual disabilities about smoking, which led to significantly lower rates of smoking.410

7.10.8 Practitioners of complementary and alternative medicine

While complementary and alternative medicine practitioners treat significant numbers of tobacco users, they are often not trained in evidence-based strategies. One study developed and evaluated a brief intervention adapted for such practitioners, and found that after three months, there were significant increases in practitioners' tobacco cessation activities, motivation, and confidence in helping patients quit, and comfort with providing information and referrals for guideline-based tobacco cessation aids. This may be an additional channel for reaching people who smoke.411 (See Section 7.18 for information on the use of alternative therapies for smoking cessation)

7.10.9 Training health professionals in smoking cessation interventions

Training clinicians in smoking cessation methods may increase patients’ cessation rates,13,412 as such training increases the number of people identified as smoking and advised to quit.413-416 Training increases health professionals’ knowledge, skills, confidence, and likelihood of practicing smoking-related interventions.170,414,415,417-424 A 2026 Cochrane review concluded that there is high-certainty evidence that training healthcare professionals in smoking cessation increases quitting among patients. More patients appeared to quit when health professionals received higher- compared with lower‐intensity training.425 Such training should include practical guidance, resources and communication skills training for delivering cessation interventions, as well as education on the clinical benefits of quitting.426 Greater assessment of tobacco cessation knowledge during exams may also improve competency in the provision of interventions.427 A review of tobacco curriculum in medical schools concluded that combining concise lecture-based curriculum with role-play or patient interactions builds the knowledge and skills necessary for undergraduate students to provide smoking cessation interventions.428 Brief cessation training and technical assistance also increases referral by health providers to specialist smoking cessation services.429,430 However there is a lack of consistency in cessation training during health professionals’ education.431 Part of the reason that some doctors may not be more actively involved in tobacco use treatment may be due to a lack of relevant training during medical school.432-434 Despite some international evidence of an increase in cessation training in medical schools over time, increased emphasis on addressing tobacco use with patients is needed.432,435 A study examining pharmacists’ training in the US noted the importance of education on cessation interventions given their expanding scope in this area.436 This may also be important in Australia, with recent legislative reforms restricting supply of vapes to pharmacies to facilitate access to vapes for people wishing to quit smoking (see Section 18.13).

Most postgraduate health professional training programs incorporate the 5As approach, stage of change, motivational interviewing, and pharmacotherapies, and commonly refer to clinical practice guidelines.437 However, one review and evaluation of online tobacco dependence treatment courses found that while many excelled in providing effective navigation, course rationale, and content, most failed to meet minimal quality standards and none of the courses evaluated could be ranked as superior.438 Further, not all practising health professionals access cessation intervention training: they report lack of interest, time pressures, and competing priorities as major barriers. Overall, smoking cessation education programs for health professionals can be fairly ‘ad hoc’ and there is a lack of a systematic organised approach to ensure availability and consistency in most countries.437

The Quit Centre provides online cessation training and clinical tools and guidelines for a range of health professionals.61 Cessation training should not only be included during training but should form a core part of ongoing professional development,274 as the knowledge and skills gained during university can often be short-lived.428 Research in the UK found that large-scale upskilling of hospital-based healthcare professionals improved provision of cessation interventions.439

7.10.10 Increasing intervention delivery and referrals

Healthcare providers and policy makers should develop and implement supportive systems, policies and training that embed the provision of cessation interventions as part of routine care.2 Along with training health professionals in smoking cessation interventions, organisational systems for routinely recording client smoking behaviour increase the effectiveness of practice,13,56,285,440,441 as it increases intervention delivery resulting in increased cessation rates.13,442 The use of electronic medical records can remind doctors and other clinic staff to record tobacco use, to give brief advice to quit, to prescribe medications, and to refer to cessation counselling services. A 2014 Cochrane review concluded that electronic records appear to increase the documentation of tobacco status and referral to cessation counselling,443 and subsequent studies have also supported the role of electronic health records in increasing the provision of cessation interventions.274,276,444-446 Many studies also support the effectiveness of a dedicated smoking cessation ‘champion’ within teams and units, whose role specifically includes promoting and delivering cessation interventions.93,447 Opt-out and proactive interventions and referrals also appear to increase tobacco use treatment and quitting behaviours compared with when patients must opt in.448,449 As well as the provision of cessation interventions, healthcare providers are also well-placed to support adherence to cessation medications, which can predict the success of quit attempts.450

An integrated, comprehensive systems approach to cessation treatment and policy can help improve the provision of cessation care, and increase quit rates.451 Australia currently has no national strategy for tobacco dependence treatment, and many opportunities to provide cessation advice and treatment are missed.452 Such a strategy could include:2,451-456

  • expanding cessation treatment coverage and provider reimbursement
  • incentive payments for the provision of smoking cessation interventions
  • mandating adequate funding for the use and promotion of evidence-based, state-sponsored quitlines
  • supporting healthcare system changes to embed tobacco treatment as part of routine care
  • increasing patients’ knowledge of the availability and effectiveness of evidence-based cessation support
  • tailoring and targeting cessation support to best meet the needs of priority and disadvantaged populations (see InDepth 9A).

A number of studies have examined how to increase health professionals’ referrals to Quitline—see Section 7.14.5 for a detailed discussion.

Related reading

Health and other benefits of quitting

7.1

Pharmacotherapies for smoking cessation

7.16

Tobacco—a leading preventable cause of death and disease

3.0

Relevant news and research

A comprehensive compilation of news items and research published on this topic

Read more on this topic

Test your knowledge

  

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Intro
Chapter 2
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RAP
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