Every VBA should include ASK : ADVISE : ACT even if the act is to simply record your VBA and the outcomes in the medical record so that it is immediately available to the next healthcare professional who encounters the patient. This may make it more likely the next heath care professional, not only uses the VBA approach, but also builds on the previous conversation. The next encounter at which VBA is undertaken may be the one that triggers a quit attempt. It can be delivered by both prescribers and non-prescribers.

The VBA intervention is simple, but its derivation is complex and considered. It condenses significant and robust behavioural research. Language matters and its use as an intervention should be taken as seriously as prescribing a medicine. VBA deliberately does not “challenge the addict” unnecessarily as this may actually reduce the power of the advice. 

For example, VBA deliberately does not:

❌ Advise the smoker to stop
❌ Ask if they want to stop
❌ Ask details about what or how much they smoke.

This is because the offer of help in itself can trigger a quit attempt and so responses to such questions are not needed at this stage and should be left to the dedicated stop smoking consultation which will hopefully follow. Providing a positive picture of what this help looks like is also important.

Every conversation with a patient about tobacco use should start with VBA by a health practitioner who has been trained to deliver this conversation. Tobacco VBA is a basic healthcare competency that has to be learned – it is not a chat – it is an evidence-based intervention. Many health practitioners speak with patients about tobacco, but this is not the same as the VBA method and not using an evidence-based approach to this conversation, can potentially prevent rather than encourage a quit attempt.

Clinicians sometimes worry about causing damage to the therapeutic relationship which may prevent raising the issue. Delivering evidence-based tobacco VBA takes away this concern in those who have been trained to deliver it. The question should be adapted for local patterns of tobacco use, for example in communities where smokeless tobacco use is prevalent. It’s important to consider also that smoking is a chronic relapsing condition so even when a patient has stopped smoking there is a risk of starting again. Ex-smokers should be asked about their smoking status until they have stopped for at least three years.

The above describes basic VBA which is designed for opportunistic delivery to any smoker in less than 30 seconds during any clinical encounter. This in the minimum which should be delivered as part of routine practice. Depending on the patient, time available and clinical circumstances, VBA can be modified and extended as necessary to improve the chance of the smoker engaging in a supported quit attempt.

Full PCRU Article

Tobacco dependency pragmatic guide

Tobacco dependency is a long-term relapsing condition that usually starts in childhood

Our tobacco dependency pragmatic guide is a practical, immediately implementable, evidence-based framework to enable healthcare professionals to routinely identify smokers, encourage a quit attempt and support that quit attempt within the real-world context of their own professional sphere.

 

Full Pragmatic Guide

If you have an understanding of tobacco dependence, then compassion follows, and you are not judgemental

Andy McEwen

Chief Executive, National Centre for Smoking Cessation and Training, 2018