Review: intensive behavioural counselling interventions are effective for smoking cessation in patients admitted to hospital
Correspondence to: Professor N Rigotti, Massachusetts General Hospital, Boston, MA, USA;
What is the effectiveness of various interventions for smoking cessation in patients admitted to hospital?
Medline, EMBASE/Excerpta Medica, PsycINFO, Cochrane Tobacco Addiction Group register (all to January 2007); CENTRAL (Issue 4, 2006); CINAHL (to August 2006); conference abstracts; bibliographies of relevant studies; and experts.
Study selection and assessment:
randomised controlled trials (RCTs) or quasi-RCTs comparing any behavioural, pharmacological, or multicomponent intervention (started in hospital) with control (included brief advice or usual care) for smoking cessation in patients admitted to hospital, who were current smokers, had quit >1 month before admission, or planned to quit after discharge. Studies of secondary prevention or cardiac rehabilitation in patients who were not recruited based on smoking history, patients admitted to hospital for psychiatric disorders or substance abuse (including tobacco addiction programmes), and studies with <6 months of follow-up were excluded. 33 trials (n = 14 454, mean age range 43−61 y based on 25 trials) met the selection criteria. Quality assessment of individual studies was based on randomisation, allocation concealment, validation of self-reported smoking cessation, and follow-up.
abstinence from smoking ⩾6 months after intervention.
Meta-analysis showed that intensive behavioural counselling (counselling plus follow-up support for >1 mo after discharge) increased smoking abstinence at ⩾6 months compared with control (table). A single, brief (<15 min) in-hospital intervention with no follow-up support after discharge (1 study), >15 minutes of counselling with no follow-up support (8 studies), or counselling plus <1 month of follow-up support (6 studies) did not differ from control. Adding nicotine replacement therapy (5 studies) or bupropion (1 study) to intensive counselling did not differ from intensive counselling alone for smoking abstinence.
Intensive behavioural counselling interventions are effective for smoking cessation in patients admitted to hospital.
Rigotti N, Munafo M, Stead L. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev 2007;(3):CD001837.
Clinical impact ratings: General/Internal medicine 6/7; General surgery 7/7; Health promotion 6/7
Source of funding: NHS Research and Development Programme UK and NIH/NHLBI USA.
The review by Rigotti et al used several measures to evaluate the included studies and increase confidence in the results, including assessing the quality of randomisation and allocation concealment, examining studies for biochemical validation of smoking cessation, and accounting for participants who dropped out. These procedures help to reduce bias and overestimation of the benefit of smoking cessation interventions. The review also included sensitivity analyses to determine if removing weaker studies and examining single components of multicomponent interventions influenced the overall results. The positive results of the review may be even stronger than calculated because many patients in the control group received more information about smoking than patients would normally receive in usual care.
The results indicate that an intensive intervention in hospital plus follow-up for ⩾1 month after discharge improves smoking cessation outcomes. In most of the studies, the smoking cessation intervention involved counselling by a research nurse or counsellor.
Although the review provides encouraging findings for hospital-based smoking cessation interventions, further research is needed to determine if clinicians, including nurses, can deliver effective and efficacious smoking cessation interventions while providing usual care to patients. Nurses, including oncology nurses, report barriers to delivering smoking cessation counselling, such as lack of knowledge of effective interventions and fears of alienating unreceptive patients.1 2 Also, patients may benefit from disease-specific smoking cessation interventions,3 which adds complexity to the delivery of interventions across patient groups. Despite these and other limitations, hospital admission can be an opportune time for nurses to engage patients in discussions of smoking cessation.