Training for Clinicians

CINSW online training lesson 3: Introducing the 3As brief intervention model

This short online lesson provides an interactive overview of the Ask Advise Act brief smoking cessation intervention

USA Prof Warren: Ask, Advise, Refer (2:55min; CINSW resource)

Presented by oncologist Prof Graham Warren, this brief video endorses the 3-step brief smoking cessation intervention and provides conversation tips for clinicians

Nurse 3As referral to Quitline (1:30min; CINSW resource)

Nurse Kerry Lang provides asks, advises about quitting and referral to Quitline at a chemotherapy appointment

Medical Oncologist 3As referral to Quitline (1:24min; CINSW resource)

Medical Oncologist Dr Deme Karikios asks, advises about quitting and referral to Quitline

Radiation therapist 3As referral to Quitline (1:20min; CINSW resource)

Radiation Therapist Su Mei Tan asks, advises about quitting and referral to Quitline

Patient asks for advice to be given at diagnosis (0:52min; C2Q resource)

“It is a healthcare professionals duty of care to inform patients the benefits of quitting”

- Patient Julie McCrossin

Oncologist follow-up appointment asking about smoking status (1:46min; ASK; C2Q resource)

Oncologist Dr Fiona Day in a follow-up consultation with patient Jessica asking about her quit attempt, and congratulating her for the success

Oncologist initial consultation appointment asking about smoking status (2:44min; ASK; C2Q resource)

Oncologist Dr Fiona Day has initial consultation with patient John (lung cancer) asking about his smoking status (pack hx, initiation, first cigarette, quit hx

Oncologist advising cessation due to negative outcomes (2:20min; ADVISE; C2Q resource)

Oncologist Dr Fiona Day with John (lung cancer). Advised to cease smoking:

• Side effects 

• Worst-case scenario is ceasing radiation treatment due to smoking

Oncologist dispels myths about cigarettes and stress (1:22min; ADVISE; C2Q resource)

Oncologist Dr Fiona Day with John (lung cancer) provides education:

• Cigarette use actually increases stress

Oncologist referral to patches and Quitline (2:21min, ACT; C2Q resource)

Oncologist Dr Fiona Day with patient Jessica 

• Jessica is struggling with cravings

• Education about patches

• Referral to Quitline

Oncologist Act/Help discussion about Quitline, NRT and Champix/Varenicline (4:03min; ACT; C2Q resource)

Oncologist Dr Fiona Day with John (lung cancer). In-depth discussion about Quitline, NRT, & Champix/Varenicline

Oncologist suggesting support groups (1:12min; ACT; C2Q resource)

Oncologist Dr Fiona Day with John (lung cancer) provides suggestions:

• Cancer support group 

• Men’s Shed

Oncologist suggesting a support person (“accountability buddy”) (0:48min; ACT; C2Q resource)

Oncologist Dr Fiona Day with John (lung cancer) provides suggestions:

• Confiding in a person who can provide support

Radiation Therapist referral (1:29min, ACT; C2Q resource)

Radiation therapist Manning Carey provides referral to social work and Quitline

Oncologist education about Quitline (0:37min; ACT; C2Q resource)

Oncologist Dr Fiona Day with patient Jessica 

• Quitline will assist with forming new habits

Nurse opinion about Quitline (2:08min; C2Q resource)

Nurse Anne Mellon describes Quitline and how to make a referral

Oncologist education about the use of patches (2:46min; ACT; C2Q resource)

Oncologist Dr Fiona Day with patient Jessica 

• Administering the patch

• Usage

• Top-up dosage is useful if cravings persist 

Pharmacist education about the NRT options (4:24min; CINSW resource)

Pharmacist Nicolas Holton provides a summary of NRT:

• Gum

• Lozenges

• Patch

• Inhaler

• Mouth spray

• Contraindications/ Precautions

Does Champix work better than NRT or other medications? (3:44min)

• Clinical Psychologist, James McLellan provides evidence that patients are more likely to quit using Champix than single-form NRT, Bupropion or placebo (27 studies)

• For non-motivated people, even low dose Champix is better than placebo (1 study) 

• Number needed to treat (for quitting) with Champix is 11, single form NRT 15-23 and Bupropion 22.

Champix drug interactions and contraindications (6:03min)

• No meaningful drug interactions however not recommended for pregnant, breastfeeding and under 18 years

• For severe renal disease – a lower dosage is recommended (50% lower dose) according to TGA / product info leaflet

• Contraindication: alcohol consumption 

• Does not directly cause serious psychiatric issues (EAGLE trial) 

• Can be used if having mental health or drug using populations

Champix dosage and administration (3min)

• There are three modes for prescribing Champix:

  • Set date to stop then start Champix 1-2 weeks before, 

  • Flexible quit date – begin dose and quit day between 8-35 days

  • Slow reduction (for unmotivated smoker) e.g. start dose, then reduce smoking with 50% in the first 4 weeks, 50% again for next 4 weeks. Aim to stop after 12 weeks.

• Go back to GP at week 3 and 11 (program is 12 weeks in total)

• Low cost and covered if having healthcare card (available on PBS)

Champix side-effects (2:30min)

• Main side-effects:

  • Nausea (most common, 30%)

  • Headache

  • Insomnia

  • Possible to increase cardiovascular adverse events

Suggested advice and language to use about Champix (3:24min)

• Common patient beliefs about using Champix

• Suggested advice for patients e.g. Champix is not the miracle cure but one slice of the pie and of the overall plan. “Its not the pie”.

Care to Quit Nicotine Replacement Therapy Pharmacotherapy Training (56:38min)

• Pharmacotherapy training session delivered by Dr James McLennan to the Calvary Mater Newcastle Oncology Department, on 30th Nov 2022

GPs on their role in supporting a patient to quit smoking (5:43min)

• GPs Dr Nin Kiu, Dr Charles Ellis, Dr Jimmy Cheng and Dr Jo Thomas discuss what they see as their role in supporting a patient to cut down or quit smoking.

Conversations about cessation with a cancer diagnosis (4:44min)

• GPs Dr Nin Kiu, Dr Charles Ellis, Dr Jimmy Cheng and Dr Jo Thomas discuss conversations about cessation with a cancer diagnosis

Reasons a GP wouldn’t address smoking cessation (0:53min)

• GP Dr Nin Kiu discusses reasons she wouldn’t address smoking cessation with a patient

Information GPs would like from the oncology team (10:32min)

• GPs Dr Nin Kiu, Dr Charles Ellis, Dr Jimmy Cheng and Dr Jo Thomas discuss what information they would like from the oncology team

GPs on the oncologists’ role in smoking cessation (6:58min)

• GPs Dr Nin Kiu, Dr Charles Ellis, Dr Jimmy Cheng and Dr Jo Thomas on the oncologists’ role in smoking cessation

Patients not willing to quit and difficult patients (2:18min)

• GPs Dr Charles Ellis, Dr Jimmy Cheng and Dr Jo Thomas discuss patients not willing to quit and difficult patients

What should the oncology team know about how GPs assist with quitting (3:36min)

• GPs Dr Charles Ellis and Dr Jimmy Cheng talk about what oncology teams should know about how they assist with quitting

Oncologist suggesting support groups (1:12min; ACT; C2Q resource)

Oncologist Dr Fiona Day with John (lung cancer) provides suggestions:

• Cancer support group 

• Men’s Shed

Oncologist suggesting a support person (“accountability buddy”) (0:48min; ACT; C2Q resource)

Oncologist Dr Fiona Day with John (lung cancer) provides suggestions:

• Confiding in a person who can provide support

Patient advice about providing advice (0:52min; C2Q resource)

Patient Julie McCrossin:

• Show that you care

• Be genuinely interested

Patient opinion about the clinician-patient relationship if smoking cessation is discussed (0:49min; C2Q resource)

Patient Julie McCrossin:

• If the health professional is authentically wanting to help the patient will listen

Oncologist suggestions with resistant patients (0:57min; C2Q resource)

Interview with oncologist Dr Fiona Day provides patients:

• With an informed choice

• Benefits of quitting

• Flag to rediscuss smoking cessation at a later time

Oncologist suggestions with patients who are struggling to quit (2:30min; C2Q resource)

Interview with oncologist Dr Fiona Day provides patients:

• Assess & reuse previous successful quit attempts

• Multiple referrals (Quitline, NRT or Champix)

• Suggests cutting down as a goal with overall aim for cessation

• Provide positive affirmation of incremental changes