Physician advice for smoking cessation
Top Cited Papers
- 31 May 2013
- journal article
- review article
- Published by Wiley in Emergencias
- Vol. 2013 (5), CD000165
- https://doi.org/10.1002/14651858.cd000165.pub4
Abstract
Background Healthcare professionals frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. Objectives The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti-smoking advice on disease-specific and all-cause mortality. Search methods We searched the Cochrane Tobacco Addiction Group trials register in January 2013 for trials of interventions involving physicians. We also searched Latin American databases through BVS (Virtual Library in Health) in February 2013. Selection criteria Randomised trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided. Data collection and analysis We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomisation and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up. We also considered the effect of advice on mortality where long-term follow-up data were available. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. People lost to follow-up were counted as smokers. Effects were expressed as relative risks. Where possible, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. Main results We identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics. Pooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (relative risk (RR) 1.66, 95% confidence interval (CI) 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56). Direct comparison also suggested a small benefit of follow-up visits. Only one study determined the effect of smoking advice on mortality. This study found no statistically significant differences in death rates at 20 years follow-up. Authors' conclusions Simple advice has a small effect on cessation rates. Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%. Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions.Keywords
This publication has 168 references indexed in Scilit:
- The Effects of a Multilingual Telephone Quitline for Asian Smokers: A Randomized Controlled TrialJNCI Journal of the National Cancer Institute, 2012
- Effectiveness of regular reporting of spirometric results combined with a smoking cessation advice by a primary care physician on smoking quit rate in adult smokers: a randomized controlled trial. ESPIROTAB studyBMC Family Practice, 2011
- An Interactive Voice Response System to Continue a Hospital-Based Smoking Cessation Intervention After DischargeNicotine & Tobacco Research, 2011
- Stage-based interventions for smoking cessationEmergencias, 2010
- Effectiveness of intensive group and individual interventions for smoking cessation in primary health care settings: a randomized trialBMC Public Health, 2010
- In-practice management versus quitline referral for enhancing smoking cessation in general practice: a cluster randomized trialFamily Practice, 2008
- Proactive interventions for smoking cessation in general medical practice: a quasi‐randomized controlled trial to examine the efficacy of computer‐tailored letters and physician‐delivered brief advice*Addiction, 2007
- Randomized Controlled Trial of a Computer-Based, Tailored Intervention to Increase Smoking Cessation Counseling by Primary Care PhysiciansJournal of General Internal Medicine, 2007
- Effects of practitioner education, practitioner payment and reimbursement of patients' drug costs on smoking cessation in primary care: a cluster randomised trialTobacco Control, 2007
- Measuring inconsistency in meta-analysesBMJ, 2003