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Review
, 12 (12), CD001188

Nursing Interventions for Smoking Cessation

Affiliations
Review

Nursing Interventions for Smoking Cessation

Virginia Hill Rice et al. Cochrane Database Syst Rev.

Abstract

Background: Healthcare professionals, including nurses, frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions.

Objectives: To determine the effectiveness of nursing-delivered smoking cessation interventions in adults. To establish whether nursing-delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow-ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking.

Search methods: We searched the Cochrane Tobacco Addiction Group Specialized Register and CINAHL in January 2017.

Selection criteria: Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow-up of at least six months.

Data collection and analysis: Two review authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically-validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed-effect model and reported the outcome as a risk ratio (RR) with a 95% confidence interval (CI).

Main results: Fifty-eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I2 = 50%) and not explained by subgroup analysis. Because of this, we judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, we did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. Subgroup analyses found no evidence that high-intensity interventions, interventions with additional follow-up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow-up or aids. There was no evidence that the effect of support differed by patient group or across healthcare settings.

Authors' conclusions: There is moderate quality evidence that behavioural support to motivate and sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence. There is insufficient evidence to assess whether more intensive interventions, those incorporating additional follow-up, or those incorporating pathophysiological feedback are more effective than one-off support. There was no evidence that the effect of support differed by patient group or across healthcare settings.

Conflict of interest statement

VHR was the principal investigator in one of the studies included in this review.

LH: None known

JLB: None known

JHB: None known

Figures

1
1
Study flow diagram for 2017 update
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Trials of nursing intervention versus control grouped by intensity of intervention. Outcome: Smoking cessation at longest follow‐up.
1.1
1.1. Analysis
Comparison 1 All nursing intervention vs control trials, grouped by intensity of intervention, Outcome 1 Smoking cessation at longest follow‐up.
2.1
2.1. Analysis
Comparison 2 All nursing intervention vs control trials, grouped by setting and population, Outcome 1 Smoking cessation at longest follow‐up.
3.1
3.1. Analysis
Comparison 3 Effect of additional strategies: Higher versus lower intensity, Outcome 1 Additional components at single contact. Smoking cessation at longest follow‐up.
3.2
3.2. Analysis
Comparison 3 Effect of additional strategies: Higher versus lower intensity, Outcome 2 Additional contacts. Smoking cessation at longest follow‐up.
4.1
4.1. Analysis
Comparison 4 Sensitivity analysis by intensity, including Hajek 2002, with Lancaster, Bolman, Curry as low intensity, Outcome 1 Smoking cessation at longest follow‐up.
5.1
5.1. Analysis
Comparison 5 Sensitivity analysis by setting and population, including Hajek 2002, Outcome 1 Smoking cessation at longest follow‐up.

Update of

  • Nursing interventions for smoking cessation.
    Rice VH, Hartmann-Boyce J, Stead LF. Rice VH, et al. Cochrane Database Syst Rev. 2013 Aug 12;(8):CD001188. doi: 10.1002/14651858.CD001188.pub4. Cochrane Database Syst Rev. 2013. PMID: 23939719 Updated. Review.

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