Telephone counselling for smoking cessation

 

Abstract

Background

Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines.

Objectives

To evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit.

Search methods

We searched the Cochrane Tobacco Addiction Group trials register for studies using free text term 'telephone*' or the keywords 'telephone counselling' or 'Hotlines' or 'Telephone' . Date of the most recent search: March 2009.

Selection criteria

Randomized or quasi-randomized controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters.

Data collection and analysis

Trials were identified and data extracted by one person (LS) and checked by a second (TL). The main outcome measure was the risk ratio for abstinence from smoking after at least six months follow up. We selected the strictest measure of abstinence, using biochemically validated rates where available. We considered participants lost to follow up to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention without the telephone component as the control group in the primary analysis. We assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I² statistic. Where appropriate, we pooled studies using a fixed-effect model. A meta-regression was used to investigate the effect of differences in planned number of calls.

Main results

Sixty-five trials met the inclusion criteria. Among smokers who contacted helplines, quit rates were higher for groups randomized to receive multiple sessions of proactive counselling (nine studies, >24,000 participants, risk ratio (RR) for cessation at longest follow up 1.37, 95% confidence interval (CI) 1.26 to 1.50). There was mixed evidence about whether increasing the number of calls altered quit rates but most trials used more than two calls. Two studies comparing different counselling approaches during a single quitline contact did not detect significant differences. Of three studies that provided access to a hotline two detected a significant benefit and one did not.

Telephone counselling not initiated by calls to helplines also increased quitting (44 studies, >24,000 participants, RR 1.29, 95% CI 1.20 to 1.38). In the subgroup of studies offering 1-2 calls the effect was small and not significant.

A further seven studies were too diverse to contribute to meta-analyses and are discussed separately.

Authors' conclusions

Proactive telephone counselling helps smokers interested in quitting. There is some evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increase the chances of quitting compared to a minimal intervention such as providing standard self-help materials, brief advice, or compared to pharmacotherapy alone. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness.

 

Plain language summary

Is telephone counselling effective as part of a programme help people stop smoking

Smoking contributes to many health problems including cancers and heart and lung diseases. People trying to quit smoking can be helped with medication or through behavioural support such as specialist counselling and group therapy. Support, information and counselling are offered either face-to-face or by telephone. Counselling via telephone hotlines can be provided as part of a programme or separately, and can potentially reach large numbers of people. Our review of trials found telephone counselling to be effective; multiple sessions are likely to be most helpful .

 

摘要

背景

電話諮詢戒菸

電話服務能提供吸菸者相關的資訊和支持。電話諮商是主動的或反應的給於來電者有關戒菸的協助。

目標

評估主動或回應式電話服務於協助吸菸者戒菸的效果

搜尋策略

我們使用關鍵字“電話諮商” “熱線” “電話” 來搜尋the Cochrane Tobacco Addiction Group trials register 。搜尋至2006年1月。

選擇標準

隨機或準隨機對照試驗的研究，包括主動或回應式的電話諮商來協助吸菸者或剛戒菸者戒菸。

資料收集與分析

由一名作者選擇研究及抽取資料，由另一名作者檢查。主要的結果測量是個案經過至少6個月的追蹤可以完全戒菸的勝算比。我們選擇對戒菸較為嚴格的測量、使用可得的生化驗證率，考慮哪些在追蹤期流失的受試可能會持續吸菸。在基本分析中，當研究多於一種處置，我們將相似的處置但沒有電話諮商的當成是控制組。臨床上比較性研究，我們使用I2統計來分析次團體的異質性分析。如果適當，我們使用固定效果模式來整合研究。後設回歸分析來驗證不同電話諮商次數的效果。

主要結論

48個試驗符合納入標準。在使用電話服務的吸菸者中，隨機分派，發現接受較多次諮商的戒菸率通常較高 (8篇研究，超過18000名參與者，長期戒菸率的勝算比(OR)為1.41，95%的信賴區間(CI) 1.27 to 1.57)。其中兩篇研究顯示比不深入的處置，較深入的處置有較名顯的好處。不是先打到戒菸專線的電話諮商的戒菸率也較高(29篇研究，超過17000名參與者，OR為1.33, 95% CI 1.21 to 1.47)。後設迴歸分析顯示打電話的次數和效應值有顯著關連。清楚的證據顯示在較強烈的動機想戒菸的團體中通常較有利。其中兩個能接觸電話諮商的研究中顯示一個研究顯示有顯著好處，另一個並沒有這樣的發現。 2個研究比較在一次的電話諮商中使用不同的諮商取向發現並沒有顯著的差異。其餘的7個研究因為差異性太大，無法進行後設分析，因此分別討論。

作者結論

主動的電話諮商幫助吸菸者較有興趣於戒菸。證據顯示似乎有次數的反應，一、兩次表淺的電話輔導很難達到可測量的進步; 比起只提供標準自助程序、簡短的建議的較少次的電話諮商或是只給藥物戒菸而言，三次或更多次的電話諮商會增加戒菸的比率。電話戒菸專線能提供給吸菸者支持的一個重要的途徑，以及回應的電話諮商更能增加他們的用處。

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

電話諮商能協助人戒菸。吸菸和許多健康的問題有關，像癌症、心臟、肺臟相關疾病。試著要戒菸的人通常經由藥物或行為的支持，像是專家諮詢或團體治療，而得到一些幫助。利用面對面的方式或是電話來給於資訊、支持和輔導。藉由電話的輔導通常是計畫的一部份或者獨立執行，這樣的方式能接觸到較多的人。這篇文獻回顧發現電話輔導是有效的，較多次的輔導則更有幫助。