Quit Insights Clinical Series Podcast with the Quit Centre clinical team on talking to patients about smoking and vaping cessation.
Listen to the podcast
Also available on:
Spotify, Apple Podcasts, Amazon Music, Deezer
and other major podcast platforms.
This podcast and article are intended for health professionals and are for educational and informational purposes only. The content discussed does not constitute medical, legal, or professional advice and should not replace your own clinical judgment.
Our podcast guests were members of the Quit Centre clinical team:
Dr Cora Mayer, Quit Centre GP Lead and practising GP with a special interest in smoking and vaping cessation; Jennifer Kyi, Quit Centre Pharmacist Advisor and practicing pharmacist with special interest in chronic disease management and preventative health; and Stacey Ridley, Quit Centre Nurse Advisor, and registered nurse working in general practice with an interest in preventative health.
Why is it important for health professionals to discuss smoking and/or vaping cessation with their patients?
Cora: From my perspective as a GP, nicotine dependence is still a significant health issue. Tobacco use has declined over time, but is still a leading risk factor for disease in Australia. In 2022 to 2023, more than 8% of people smoked tobacco every day, and in 2024, it contributed to nearly 8% of the disease burden, which is really significant.
In regards to e-cigarettes, or vapes, their use was first identified in Australia in around 2007. Since 2016, their use has been increasing so much so that it has become a major health concern, especially in teenagers and young adults.
We know that quitting has immediate as well as long-term health benefits. Quitting reduces risks for diseases caused by smoking, and improves health in general. In fact, discussing cessation is one of the most important preventative health interventions overall.
What framework can be used for having a conversation with a patient about smoking and/or vaping? Can you explain more about the Ask, Advice, Help - or AAH approach.
Jen: I’m a pharmacist but this really applies to all clinicians. The way I have the conversation is by using an established framework such as Brief Advice. It’s a powerful approach which helps set up the conversation for everyone, for patients who are ready to quit, and also opens up the conversation for those who are not ready to quit.
So Quit has developed the three-step brief advice approach (Ask, Advise, Help). The conversation can go from one to three minutes, and connects patients to best practice cessation care, which engages them to pharmacotherapy if appropriate, as well as multi-session behavioural intervention. The conversations are tailored and can be delivered to individual patients and weaved into different clinical settings or workflows, including a fast-paced pharmacy or during a clinical service. It’s also important to note that brief advice does not require an assessment of motivation and includes help for everyone, even those who are not ready to quit.
This is important as it signals to patients that your pharmacy is a place they can return to when they’re ready to take the next step.
Stacey: As a nurse, I bring up the AAH (Ask, Advise, Help) model in everyday practice – when doing care plans and updating the patient’s file. In the treatment room, with spirometry, wound care, or vaccinations, I weave it into the conversation. During accreditation and updating the patient’s status is a great opportunity to talk about smoking cessation.
Cora: In general practice, Ask, Advise, Help can be done very quickly in a consultation, even if there isn’t much time. You’d start by asking the patient whether they smoke or vape, plus or minus a few follow up questions, and offer advice to quit that is personalised to their particular context. So you might say “quitting smoking will help you feel better and reduce your blood pressure” or with a pregnant patient, you might say “quitting can greatly increase the chances of you having a healthy pregnancy and a healthy baby”.
You can then offer help by arranging a referral to Quitline and facilitating access to pharmacotherapy if clinically appropriate.
There’s a really helpful chart available on our website which includes the conversation starter and examples on how you can have the Ask, Advise, Help conversation, and also the steps to follow through.
Can you share some examples of clinical situations where you’ve had a conversation about smoking and/or vaping?
Stacey: In a nursing setting, these conversations can be life-changing. I have seen a patient who was an elderly gentleman with a venous ulcer on his ankle, which was slow-healing. He had co-morbidities of type 2 diabetes, hypertension and peripheral neuropathy, and I spoke to him many times about how smoking causes damage to blood vessels, delays wound healing and contributes to the formation of venous ulcers. He wasn’t very compliant for a long time but with the slow healing of the wound, after a while he realised he needed to quit and he approached me on a subsequent visit – after many times of me asking him – and was happy to try to quit again.
Jen: In a community pharmacy these conversations don’t need to happen in a formal setting. They often come up in everyday interactions, which might include medicine counselling, for example a patient on a new cardiovascular medication. Or while I’m providing clinical services such as wound care, vaccinations, or during diabetes medications checks. Even during product-based requests, such as patients asking for a salbutamol inhaler. The opportune moment for pharmacists really is about recognising these touchpoints and making the cessation care part of the service that we are already providing, rather than considering it a separate formal discussion.
Cora: As a GP, we are asking this question all the time, from young teenagers vaping, all the way through to elderly patients who might have chronic health conditions. My most recent Quitline referrals were for an adult patient who came in for a travel consultation, where I asked about smoking and was able to provide brief advice in that context, and another adult patient who was under a lot of stress, had taken up smoking again after quitting some time ago, and together we discussed pharmacotherapy options and worked out a good time to tackle quitting again.
How do you approach the conversation, depending on the patient?
Cora: I find it most helpful to personalise the conversation to the specific patient and their specific context, and to consider where they’re at in their quitting journey, knowing that it can be normal to take many attempts to finally quit; to be curious, compassionate, and to meet the patient where they’re at.
Jen: My approach really depends on understanding that tobacco dependence in a chronic relapsing condition driven by nicotine addiction. It’s less of a lifestyle or behaviour choice and requires supportive, evidence-based care. When I’m having a conversation with my patient, my starting point is knowing the best way to quit, for smoking cessation support, that’s the use of both pharmacotherapy, and behavioural intervention, such as Quitline.
Pharmacotherapy helps to manage the nicotine addiction by reducing cravings and withdrawal symptoms. Multi-session behavioural intervention is critical because it helps people to identify triggers, build coping strategies, and gradually shift their identity from someone who smokes to someone who doesn’t. And these two treatments are complimentary.
Stacey: I try to make it conversational in the treatment room, but slightly more formal in the care plan room because there is a bit of box-ticking to do there. In the treatment room, I tell patients that I need to update their medical record, and then I can ask the question about smoking. When taking observations like blood pressure, it’s an easy way to bring up smoking status, for instance when someone has high blood pressure. During iron infusions I have a bit more time to spend with patients, so I can stand by their side and have a conversation then, I find that useful. The other place is the care plan room – there is a specific question about smoking within the format that we use, so I can include vaping there as well – and I do this, especially with young people.
How might you keep the door open for future discussions if the patient isn’t ready to quit?
Stacey: It’s important to not give up on your patients. Acknowledge they may not be ready but let them know you will check in later. Let them know it’s a journey and many people take multiple attempts to quit. Follow up during subsequent appointments and make sure to document in their records so you don't forget conversations, and have clarity on where they’re at. In addition to this, I hand over some take home resources for the patient to read in the meantime.
Would long -term patients who have been resistant or not ready to quit be interested if there’s been a change in their life circumstances or those of family members?
Stacey: Yes, definitely a change in health status such as a cancer diagnosis can certainly be a trigger for change. Or with expecting parents – you might be giving a pertussis vaccine and you can bring up the conversation then.
What would be your key takeaways in helping patients with smoking and vaping cessation?
Stacey: That one of the most important things your patient can do for their health is to Quit. They are unlikely to ask for help from you as a nurse, but as a nurse, you can have a life-changing impact on their health. Be opportunistic and ask every patient, where possible, about their smoking and vaping status.
Jen: Tobacco dependence is a chronic condition, underpinned by nicotine addiction – and less of a lifestyle choice. Most people attempt to quit multiple times before achieving longtime success.
So it’s very normal to have slip ups, and relapse. Like other chronic conditions, cessation should be managed in a structured ongoing way, with monitoring, dose adjustments as needed, and consistent follow-up and support.
Cora: As Jen says, quitting is an ongoing process, like a journey, with ups and downs and potentially lapses and repeated attempts, and it’s helpful to normalise this for the patient.
The other, very important thing for us as health professionals – as nurses, pharmacists and GPs – is to recognise the crucial role we each play in starting the conversation and helping a patient to quit, and to work together whenever we can, so the patient hears the message to quit from each health professional they come into contact with. There is evidence that the delivery of smoking cessation intervention by more than one type of health professional has the potential to increase quitting and readiness to quit, so this approach from multiple points of contact can be very powerful and synergistic.
So patients should see their health professionals as a team there to support them?
Cora: Absolutely!
We thank our guests, Dr Cora Mayer, Pharmacist Adviser Jennifer Kyi and Nurse Advisor Stacey Ridley for these really useful insights.
References:
Greenhalgh, EM, Stillman, S and Ford, C. 7.10 Role of health professionals and social services. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne : Cancer Council Victoria; 2025. Available from https://www.tobaccoinaustralia.org.au/chapter-7-cessation/7-10-role-of-general-practice-and-other-health-pro
An LC, Foldes SS, Alesci NL, Bluhm JH, Bland PC, et al. The impact of smoking-cessation intervention by multiple health professionals. American Journal of Preventive Medicine, 2008; 34(1):54-60. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18083451
Further information:
Quit Centre
Research
Tobacco in Australia: Facts & Issues