Communication
CPSA · Communication · Information giving
Behaviour change — smoking, alcohol, weight
Very brief advice plus a referral beats a lecture every time. The mark is for eliciting motivation and offering a route, not for listing harms the patient already knows.
The framework
Ask and assess
- Ask permission to discuss it. Establish current use, previous attempts and what happened.
- Assess readiness — importance and confidence, out of ten. The gap tells you where to work.
Advise briefly
- One sentence of personalised benefit, not a catalogue of risks.
- Be explicit that the most effective route is support plus pharmacotherapy, not willpower.
Act
- Smoking: refer to the local stop-smoking service, offer NRT or varenicline. Very brief advice is Ask–Advise–Act.
- Alcohol: score with AUDIT-C; offer brief intervention, and specialist referral where dependent — never abrupt cessation in dependence, because of withdrawal seizures.
- Weight: agree one specific change; consider referral to a structured programme.
Follow up
- Book a specific review. Relapse is expected, not failure — say so before it happens.
Phrases that work
- “Would it be alright if we spent a couple of minutes talking about your smoking?”
- “On a scale of one to ten, how important is stopping to you right now? … And how confident do you feel?”
- “The best evidence is that people are about three times more likely to succeed with support and medication than on their own.”
- “Most people who stop have tried before. It is not a failure, it is practice.”
Pitfalls that lose marks
- Listing harms the patient can already recite — it produces resistance, not change.
- Advising cessation with no referral and no pharmacotherapy, which achieves almost nothing.
- Telling an alcohol-dependent patient to stop abruptly — withdrawal can kill.
- Moralising, or using the word “should”.
- Not asking permission first.