Promoting cessation in hospitalized smoking patients: a systematic review

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Abstract

SUMMARY OBJECTIVES The objective of this review was to evaluate high intensity post-discharge follow-up strategies to promote smoking cessation in hospitalized patients. METHODS A systematic review was performed, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA – P) protocol. The databases used for research were: PubMed, LILACS/BIREME, Scopus, Web of Science, Cochrane and Scielo. The included articles were randomized clinical trials, published from 1990 to 2018, which evaluated in-hospital and post-discharge intervention, and provided a minimum of 30-day care post discharge. The studies aimed to evaluate tobacco cessation. RESULTS Fourteen studies were selected for analysis. Across studies, pharmacotherapy was consistently effective for smoking cessation. Communication technologies likewise were consistently effective for cessation and post-discharge access. CONCLUSION Effective strategies exist. The challenge for future trials is to determine the best approaches for different clinical contexts, to promote cessation.

Translated abstract

RESUMO OBJETIVO O objetivo deste estudo foi avaliar as estratégias no acompanhamento pós-alta para a promoção da cessação no paciente tabagista hospitalizado. MÉTODOS Foi realizada uma revisão sistemática tomando-se por referência o protocolo Preferred Reporting Itens for Systematic Rewiews and Meta-Analyses (Prisma–P). Foram utilizadas as seguintes bases de dados: PubMed, Lilacs/Bireme, Scopus, Web of Science, Cochrane e SciELO. Os artigos incluídos foram ensaios clínicos randomizados, publicados entre 1990 e 2018, que promoveram intervenções durante e após a alta hospitalar, intervenções essas que se mantiveram pelo período mínimo de 30 dias após a alta. Os estudos deveriam ter como desfecho a avaliação da cessação do tabagismo. RESULTADOS Quatorze estudos foram selecionados para a análise. A revisão dos artigos destacou a farmacoterapia como elemento importante para a promoção da cessação, bem como o uso das novas tecnologias de comunicação no acesso pós-alta. CONCLUSÃO Ainda se impõe como um desafio o aprimoramento das estratégias de follow-up após a alta hospitalar para se adequarem aos contextos locais e alcançarem melhores taxas de cessação.

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Most cited references 19

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Individual behavioural counselling for smoking cessation.

Tim Lancaster, Lindsay Stead (2017)

Individual counselling from a smoking cessation specialist may help smokers to make a successful attempt to stop smoking.

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Evidence of real-world effectiveness of a telephone quitline for smokers.

Gary Tedeschi, Dave E. Johnson, Jeffrey Terrell … (2002)

Telephone services that offer smoking-cessation counseling (quitlines) have proliferated in recent years, encouraged by positive results of clinical trials. The question remains, however, whether those results can be translated into real-world effectiveness. We embedded a randomized, controlled trial into the ongoing service of the California Smokers' Helpline. Callers were randomly assigned to a treatment group (1973 callers) or a control group (1309 callers). All participants received self-help materials. Those in the treatment group were assigned to receive up to seven counseling sessions; those in the control group could also receive counseling if they called back for it after randomization. Counseling was provided to 72.1 percent of those in the treatment group and 31.6 percent of those in the control group (mean, 3.0 sessions). The rates of abstinence for 1, 3, 6, and 12 months, according to an intention-to-treat analysis, were 23.7 percent, 17.9 percent, 12.8 percent, and 9.1 percent, respectively, for those in the treatment group and 16.5 percent, 12.1 percent, 8.6 percent, and 6.9 percent, respectively, for those in the control group (P<0.001). Analyses factoring out both the subgroup of control subjects who received counseling and the corresponding treatment subgroup indicate that counseling approximately doubled abstinence rates: rates of abstinence for 1, 3, 6, and 12 months were 20.7 percent, 15.9 percent, 11.7 percent, and 7.5 percent, respectively, in the remaining subjects in the treatment group and 9.6 percent, 6.7 percent, 5.2 percent, and 4.1 percent, respectively, in the remaining subjects in the control group (P<0.001). Therefore, the absolute difference in the rate of abstinence for 12 months between the remaining subjects in the treatment and control groups was 3.4 percent. The 12-month abstinence rates for those who made at least one attempt to quit were 23.3 percent in the treatment group and 18.4 percent in the control group (P<0.001). A telephone counseling protocol for smoking cessation, previously proven efficacious, was effective when translated to a real-world setting. Its success supports Public Health Service guidelines calling for greater availability of quitlines. Copyright 2002 Massachusetts Medical Society

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A systematic review of interventions for smokers who contact quitlines.

Rafael Perera, L Stead, Tim Lancaster (2007)

To evaluate the effect of different types of adjunctive support to stop smoking for individuals contacting telephone "quitlines," including call-back counselling, different counselling techniques and provision of self help materials. This review includes quitline studies identified as part of Cochrane reviews of telephone counselling and self help materials for smoking cessation. We updated the searches for this review. We included studies that were randomised or quasi-randomised controlled trials of any quitline or related service with follow-up of at least six months. Data were extracted by one author and checked by a second. The cessation outcome was numbers quit at longest follow-up taking the strictest definition of abstinence available, and assuming participants lost to follow-up continued to smoke. We identified 14 relevant studies. Eight studies (18 500 participants) comparing multiple call-backs to a single contact increased quitting in the intervention group (Mantel-Haenszel fixed effect odds ratio 1.41, 95% confidence interval 1.27 to 1.57). Two unpublished studies without sufficient data to include in the meta-analysis also reported positive effects. Three call-back trials compared two schedules of multiple calls. Two found a significant dose-response effect and one did not detect a difference. We did not find consistent differences in comparisons between counselling approaches (two trials) or between different types of self help materials supplied following quitline contact (three trials). Multiple call-back counselling improves long term cessation for smokers who contact quitline services. Offering more calls may improve success rates. We failed to detect an effect of the type of counselling or the type of self help materials supplied as adjuncts to quitline counselling.

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Author and article information

Journal

Journal ID (publisher-id): ramb

Title: Revista da Associação Médica Brasileira

Abbreviated Title: Rev. Assoc. Med. Bras.

Publisher: Associação Médica Brasileira (São Paulo, SP, Brazil )

ISSN (Print): 0104-4230

ISSN (Electronic): 1806-9282

Publication date (Print and electronic): June 2020

Volume: 66

Issue: 6

Pages: 849-860

Affiliations

[4] Kansas City Kansas orgnameUniversity of Kansas Medical Center orgdiv1Department of Population Health USA

[5] Juiz de Fora Minas Gerais orgnameUniversidade Federal de Juiz de Fora orgdiv1Departamento de Saúde Coletiva Brazil

[1] Juiz de Fora Minas Gerais orgnameUniversidade Federal de Juiz de Fora orgdiv1Faculdade de Medicina orgdiv2Departamento de Clínica Médica Brazil

[2] Juiz de Fora Minas Gerais orgnameUniversidade Federal de Juiz de Fora orgdiv1Faculdade de Medicina Brazil

[3] Juiz de Fora Minas Gerais orgnameUniversidade Federal de Juiz de Fora orgdiv1Faculdade de Medicina Brazil

Article

Publisher ID: S0104-42302020000600849 Publisher ID: S0104-4230(20)06600600849

DOI: 10.1590/1806-9282.66.6.849

SO-VID: 47e69e4b-4589-428d-93dc-ed8a508ead67

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date received : 25 November 2019

Date accepted : 08 December 2019

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Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 12

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SciELO Brazil

Keywords: Revisão sistemática,Hospitalization,Smoking cessation,Abandono do uso de tabaco,Abandono do hábito de fumar,Patient discharge,Hospitalização,Tobacco use cessation,Alta do paciente,Systematic review

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Keywords: Revisão sistemática, Hospitalization, Smoking cessation, Abandono do uso de tabaco, Abandono do hábito de fumar, Patient discharge, Hospitalização, Tobacco use cessation, Alta do paciente, Systematic review

Promoting cessation in hospitalized smoking patients: a systematic review

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Abstract

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SciELO Brazil

Most cited references 19

Individual behavioural counselling for smoking cessation.

Evidence of real-world effectiveness of a telephone quitline for smokers.

A systematic review of interventions for smokers who contact quitlines.

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