Physician advice for smoking cessation

 

Abstract

Background

Healthcare professionals frequently advise patients 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. Date of the most recent search: September 2007.

Selection criteria

Randomized 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 randomization 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. Subjects lost to follow up were counted as smokers. Effects were expressed as relative risks. Where possible, meta-analysis was performed using a Mantel-Haenszel fixed effect model.

Main results

We identified 41 trials, conducted between 1972 and 2007, including over 31,000 smokers. In some trials, subjects 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 1to 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.

 

Plain language summary

Does advice from doctors encourage people who smoke to quit

Advice from doctors helps people who smoke to quit. Even when doctors provide brief simple advice about quitting smoking this increases the likelihood that someone who smokes will successfully quit and remain a nonsmoker 12 months later. More intensive advice may result in slightly higher rates of quitting. Providing follow-up support after offering the advice may increase the quit rates slightly.

 

摘要

背景

醫師建議戒菸

健康照護專家經常勸告病人戒菸來改善他們的健康。這樣的勸告可能是簡短的，或者是其他更進一步處置中的一部分

目標

這篇文獻的目標是評估醫師的建議對於增加戒菸的效果如何；比較醫師給予最少的建議到給於較深入的處置；評估促進戒菸的各種諮詢意見的輔助措施的效果，並確定提供吸菸對於特定疾病和各種原因的死亡率的效果

搜尋策略

我們搜尋the Cochrane Tobacco Addiction Group trials register and the Cochrane Central Register of Controlled Trials (CENTRAL). 搜尋至2004年3月

選擇標準

戒菸的隨機試驗，由一個臨床醫師建議，在第一次建議後至少6個月內評估

資料收集與分析

我們到場所去摘錄資料，抄寫給予那一種建議(最少或深入)，當建議時是否有輔助、測量結果、隨機的方法及追蹤的完成情形。主要的結果測量是戒菸後至少6個月的追蹤和死亡率。在每個試驗中我們使用最嚴格的戒菸定義，取得可以的生化驗證率。失去追蹤的個案當成是持續吸菸者。在後設分析上，儘可能的使用MantelHaenszel fixed effect model

主要結論

我們確認出39篇的研究，發表在1972年至2003年之間，共包含31,000位吸菸者。在一些試驗中，個案是一些特定疾病的高危險群(胸腔疾病、糖尿病、缺血性心臟病)，大部分的個案並未接受篩選。最常給予忠告的地方是診所，其他的場所包括醫院的病房、門診、公司的健康中心。整合17篇有關簡短建議和沒有建議(一般照護)試驗的資料，但是在戒菸的勝算比呈現出一點點但有顯著增加(勝算比 1.74, 95% 信賴區間 1.48 to 2.05). 絕對差戒菸率在2.5％左右。根據醫師建議的處遇的強度、追蹤的量以及在當時的諮詢時除了諮商意見外，是否使用各種不同輔助措施，而這些間接的比較中並沒有足夠的證據形成顯著的差異。對深入的建議和簡短建議的直接比較顯示深入的建議呈現小優勢(odds ratio 1.44, 95% confidence interval 1.24 to 1.67). 。直接的比較也顯示在後續追蹤拜訪的一個小優點。只有一個試驗確定戒菸建議對死亡率的影響。它發現在20年的後續追蹤中，死亡率並無統計上的顯著差異

作者結論

單純的建議對於戒菸率只有很小的效果。 額外的輔助措施似乎只有很小的效果，但更深入的處遇是稍微比最小處遇有效

翻譯人

本摘要由彰化基督教醫院胡淑惠翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

是否來自醫師的忠告能鼓勵吸菸者戒菸?即使醫師只是提供有關戒菸的簡短忠告，這樣也能增加一些吸菸的人成功戒菸12月。而更深入的處置也只能增加稍高的戒菸率。給予戒菸的建議後再持續給於支持也只能輕微的增高戒菸率