In this episode of the Quit Insights Clinical Series Podcast, Teresa from Quitline joins us to discuss how health professionals can use behavioural support to complement Quitline referrals.
What you'll take from this episode:
- Best practice approaches to raising the conversation about smoking and vaping cessation with patients.
- Behavioural strategies that complement pharmacotherapy and support quitting success.
- Techniques to encourage motivation, confidence and resilience through repeated quit attempts.
- Practical ways to integrate cessation support and Quitline referrals into routine clinical care.
Teresa
Teresa has worked as a Quitline counsellor for 10 years. With a Master's degree in Counselling, Teresa is the training-lead for all new Quitline counsellors across Victoria, South Australia, Western Australia, the Northern Territory and the Australian Capital Territory. She also works as a cessation counsellor at Better Health Network (BHN) with clients with complex comorbidities, and provides education to health professionals about smoking and vaping cessation.
[00:00:00] Paulette: This Quit Insights Clinical Series podcast is recorded on Wurundjeri Woi Wurrung Country. We acknowledge the traditional custodians and pay our respects to elders past and present, and we extend that respect to those on the lands where you're listening today. This podcast is intended for health professionals and is for educational and informational purposes only. The content discussed does not constitute medical, legal or professional advice and should not replace your own clinical judgement. Welcome. I'm Paulette Trevena and this is the Quit Insights Clinical Series Podcast for health professionals. Each of our episodes bring you in-depth information and insights from professionals who are experts in smoking and vaping cessation. Our guest today is Teresa, who has worked as a Quitline counselor for ten years. With a Master's degree in Counselling, Teresa is the training lead for all new Quitline counsellors across Victoria, South Australia, Western Australia, the Northern Territory, and the ACT. She also works as a cessation counsellor at Better Health Network, or BHN, with clients with complex comorbidities, and provides education to health professionals about smoking and vaping cessation. Welcome Teresa, and thank you for being our podcast guest today.
[00:01:19] Teresa: Thank you. It's great to be here.
[00:01:21] Paulette: In this episode, we'll be exploring the best practice behavioural strategies to support people to quit smoking and or vaping. Quitting smoking and or vaping can take multiple attempts, and each individual may require different approaches. While pharmacotherapy can play an important role, behavioural support and strategies are also key components of helping people make and sustain a quit attempt. Health professionals are well placed to support patients throughout their quitting journey, including those who may not feel ready to quit, have experienced quit attempts in the past, or have varying levels of motivation and confidence. In this episode, we explore practical and best practice behavioural strategies that health professionals can use to better support their patients, and how these approaches can be applied to both smoking and vaping cessation in busy healthcare settings. So, Teresa, in your experience, how can health professionals raise quitting smoking or vaping with a client?
[00:02:17] Teresa: Well, I think to begin with, it's really important to start the conversation, not necessarily a tick box sort of question, asking more around things like, you know, tell me a bit more about your smoking or your vaping, and sort of how that fits into their life. That's an important part to explore that does help the client not feel sort of attacked I guess, that there's interest in them, that they're being asked questions of interest. And that's really important.
[00:02:45] Paulette: Yeah. And I guess being non-judgemental is really important.
[00:02:49] Teresa: Yeah. So often when people do go to health settings, one of the first questions that you see on a box that you got to tick is ‘Do you smoke?’ You know, so it can put people on the back foot and be nervous in conversations around other health issues and how they may be judged by the health professional, because that's the question ‘Oh so you smoke, do you?’ It's more around going, ‘Oh, I've noticed that you ticked that you're smoking. I'd be really, really interested to hear more about that. Can you tell me a bit about your smoking?’ Sort of encourage that style of questioning.
[00:03:20] Paulette: Right. Okay. So what is the best way to quit smoking or vaping?
[00:03:25] Teresa: So what we do know is the best way to quit is to offer, you know, behavioural counselling to support people in understanding their triggers, you know, the reasons why it's so hard and so difficult for them. And part of that is actually using a form of pharmacotherapy, you know, such as nicotine replacement therapy, for instance. So then that will help with the nicotine withdrawal aspect.
[00:03:50] Paulette: And what are your ideas for suggesting using Quitline in a conversation with a client?
[00:03:53] Teresa: Part of that is to sort of weave that question in a bit. So, once they've identified that the relationship or the connection with their patient, and the patient feels supported at that moment, it's then encouraging questions around, you know, ‘What do you know about Quitline and how they could help you?’ Sometimes people might respond ’Oh, they just force people to stop smoking’ or ’They tell us what to do’ because they actually really don't know what it's about. And so, part of that would be to explain to the client what Quitline’s about, you know, that they're not there to force anyone to stop smoking. The conversations generally start around understanding someone's smoking behaviour and how we can help them with that. So that's something that the health professional can gently weave into those conversations.
[00:04:46] Paulette: Right. Okay. And what are your ideas for suggesting using Quitline in a conversation with a client?
[00:04:50] Teresa: Encouraging to call Quitline to have that conversation. So, you know, how would you feel about giving Quitline a call, or I can refer you if you like, and they can talk to you about the process around whether they want to stop smoking and to use medications that can help and sort of just explain that it's not dictating or telling or punitive, it's really about the flow of conversation and then see what they actually know. Because sometimes people do know, they may have contacted Quitline before. You know, people don't know that. So and part of that is also in the discussion around previous quit attempts. How have they tried, what have they done? Have they spoken to Quitline before? Often health professionals will give information, but they actually don't know what that patient knows. Right. Yeah. So encouraging conversation. What do you know about Quitline or pharmacotherapy or anything like that?
[00:05:51] Paulette: So you mentioned before about when a patient is ready or not ready to quit. What about when someone isn't ready to quit? What's the approach there?
[00:05:59] Teresa: Yeah and look, you know, sometimes people aren't. And, you know, like I was mentioning before, people do get their back up because they don't want to quit smoking or quit vaping. So, we often just encourage people to, when you're ready or when you're interested in just having a conversation, that's all it’s about, just having a conversation, finding out what their motivation is. If they have no interest in wanting to stop, the conversations can happen at a later time. It's not about now or nothing. That's not the truth or the case. It's actually about - if it's not now, that's okay, but I'm here if you want to talk about it in the future.
[00:06:35] Paulette: I was really surprised to learn with Quitline that patients can plan their quit attempt ahead with Quitline. I didn't know about that before, so that must be a valuable thing.
[00:06:45] Teresa: Yeah, it's a great thing because often when we, you know, when people are wanting to think about quitting, it gets very scary. There's a real fear there. And so we want to be able to say, ‘How about we talk about this and work out a plan that's right for you?’ Whatever that may be.
[00:07:05] Paulette: Yeah, that sounds good. What are the types of questions that can help boost a client's motivation?
[00:07:09] Teresa: More so around ‘What's important to you?’ or ‘What is it that you're wanting to make changes now?’ Because sometimes people may have different reasons at another time. Like previously, if they've quit before and then they've gone back, the time that they're thinking about it then and there, it's a different reason. So we want to encourage what are the reasons to make changes or wanting to stop smoking or vaping, for instance. And it might mean health reasons, family, grandchildren, finances, depends on the person. And part of that is encouraging that plan talk and also developing skills around that, exploring the skills, you know, and that might be certain strategies that might have helped in the past or come up with new ones. And that will tend to keep, you know, encourage confidence and will keep the motivation going.
[00:08:03] Paulette: Right. Okay. How do you think health professionals can help patients to build confidence after previous quit attempts?
[00:08:09] Teresa: This is actually one of my favourites. I really do love this. And I really like this question. And the reason why, is that previous quit attempts are foundation building blocks to get to the, I guess, the permanent time. And that's why, the reason why I really love this question, or people who have quit several times, is because they learn something new every single time they quit. So they can bring something to the table in conversation. If someone stops smoking for, say, two, three, four, six months or something, or maybe even a year, I often like to ask them, ‘What did you love about being quit?’And it's great because they go, oh, you know, well, I felt free. I didn't have to plan to go out and have a cigarette, or I didn't have to think about when I was smoking next or, you know, vaping how often I have to vape or I've got it in my hand all the time. And so when that freedom comes in, it's a really lovely thing to hear because the whole body is showing how much they really enjoy. And I can hear it through the phone, you know, the excitement of, you know, their breathing's better, their exercise capacity is increased. There's also so many wonderful benefits. And it's trying to sort of stay away about that relapse discussion. You know, it doesn't mean you can't have it. It just means ‘It sounds like you really loved not smoking and sounds like you're really fed up with it and frustrated. So now it's a time to have another go. And remember where you've come from.’ That reflection.
[00:09:47] Paulette: Focusing on the positive aspects of quitting last time.
[00:09:51] Teresa: Absolutely, yeah yeah.
[00:09:52] Paulette: Oh, that's interesting, isn't it? Can you explain behavioural strategies for quitting smoking?
[00:10:00] Teresa: Yes. So that's part of that skills building I was talking about before. So when we sort of explore someone's idea of what that might mean to stop smoking or vaping, it kind of means what would work for them. So particularly, let's just say we're talking before about someone quitting before, what did they use? What did they do? You know, what worked for them? What didn't work for them? There's no hard and fast rule and none of this is linear. So we really want to be able to encourage conversations around, okay, so what worked? Well.. I loved going for a walk in the morning with my dog. And I don't smoke or vape with my dog when I walk them. I really loved that and I found that that worked for me. Is that something that you're willingto try or wanting to give it a go again? You know, what else can you bring into this? So we really explore and unpack strategies and ideas, but from them, the patients know what's going to work for them because they're the expert on them. When we actually, you know, talk with people around planning to stop smoking, we often encourage the discussions around the three tasks of their attempt to stop smoking and so it's important for them to, when they've worked out, when they're going to quit and then they stop smoking, they may be making that quit attempt and then part of that is learning and managing that physical withdrawal aspect. And like I previously mentioned, using something like a pharmacotherapy to help with that, that will ease off that intensity. And so they manage that physical withdrawal with that. And as they go along, they're adjusting to their smoke free life. And sometimes that adjustment means it's about, what am I missing? Do I feel like one? I've got a smoking thought that's popped in that I need to address or what's my craving or my thoughts about that now. And that's part of that adjustment. Because when they’restopping smoking, there are three aspects that they're working with. The physical withdrawal is one, which is what the pharmacotherapy can help with. Then there's habits. So habits, rituals, routines that the cigarettes are designed around. And also the psychological dependence, so that real emotional need to have a cigarette. And for example, that would be anxiety, stress, frustration, anger, any of those sorts of things where it's like, I've got to have a cigarette, I just need to have one. And that would be vaping as well. So you're looking at that as the main reasons around how to manage stopping smoking.
[00:12:36] Paulette: Right. Okay. Are behavioural strategies the same for quitting smoking and quitting vaping?
[00:12:41] Teresa: Well, yes, in some instances. It's really about understanding their vaping use. Because sometimes people who have used vapes to stop smoking, they can understand the difference between smoking and vaping. Essentially, people can really vape anywhere and sneakily so, you know, secretively and it's not offensive where smoke is offensive. So they also, you know, have got the vape in their hand all the time. So they don't put the vape down and then have to go out an hour later, you know, so they'll have it in their hand and they'll do it everywhere. So they notice the difference between the dependency of nicotine versus smoking. So exploring that even further is how to bring skills into, or strategies into, the home for instance. A lot of people don't smoke inside the house, but vaping people will. So how do they, you know, what do they do? So sometimes people will put the vape somewhere else in the house, which means they have to get up and go and get it. Or they put it outside or they leave it in their car where you can do these things with smoking as well, but there's usually a bit more of a gap with smoking compared to vaping. So it is, but I think there's more unpacking that needs to be done.
[00:14:02] Paulette: Right. Yeah. Okay. So what would your recommendations be for doing this in a busy health professional setting?
[00:14:08] Teresa: Yes. And I do feel for the health professionals in this area. I really do. Because it's trying to get these health questions asked and trying to be as empathetic as you can, you know, without sort of booting them out the door, I guess. So basically, it's just really asking questions again. So ask, you know, advise and help. So which we understand is the Ask, Advise, Help model and then referring to Quitline from there. So that's kind of the, I guess the quickest answer I can give you. But really it's just ’Tell me about your smoking’ and try and keep it brief, I guess. But, um, it's just referring to the Quitline. You know. And also, you know, health professionals really do have to understand what Quitline is. And a lot don't. So we really need to encourage the health professionals to understand how Quitline works, for them to be able to then refer us.
[00:15:05] Paulette: Yes. And we have covered that in a previous podcast, actually. People can listen to that. I guess the other thing is that health professionals can see Quitline as an ally, which helps them through this process.
[00:15:15] Teresa: Absolutely.
[00:15:17] Paulette: Thank you so much to our guest, Teresa from Quitline for sharing your experience and insights on this topic today.
[00:15:22] Teresa: You're welcome.
[00:15:23] Paulette: We invite listeners to visit the Quit Centre website at quitcentre.org.au for more information and resources for health professionals, and for referring patients to Quitline. And thank you for listening today. Please listen in for future episodes of the Quit Insights Clinical Series podcast.
This podcast is intended for health professionals and is for educational and informational purposes only. The content discussed does not constitute medical, legal, or professional advice and should not replace your own clinical judgement.