Motivational interviewing for smoking cessation

 

Abstract

Background

Motivational Interviewing (MI) is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help smokers to a make a successful attempt to quit.

Objectives

To determine the effects of motivational interviewing in promoting smoking cessation.

Search methods

We searched the Cochrane Tobacco Addiction Group Specialized Register for studies with terms (motivational OR motivation OR motivating OR motivate OR behavi* OR motivat*) and (interview* OR session* OR counsel* OR practi*) in the title or abstract, or as keywords. Date of the most recent search: April 2009.

Selection criteria

Randomized controlled trials in which motivational interviewing or its variants were offered to smokers to assist smoking cessation.

Data collection and analysis

We extracted data in duplicate. The main outcome measure was abstinence from smoking after at least six months follow up. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow up were treated as continuing smokers. We performed meta-analysis using a fixed-effect Mantel-Haenszel model.

Main results

We identified 14 studies published between 1997 and 2008, involving over 10,000 smokers. Trials were conducted in one to four sessions, with the duration of each session ranging from 15 to 45 minutes. All but two of the trials used supportive telephone contacts, and supplemented the counselling with self-help materials. MI was generally compared with brief advice or usual care in the trials. Interventions were delivered by primary care physicians, hospital clinicians, nurses or counsellors. Our meta-analysis of MI versus brief advice or usual care yielded a modest but significant increase in quitting (RR 1.27; 95% CI 1.14 to 1.42). Subgroup analyses suggested that MI was effective when delivered by primary care physicians (RR 3.49; 95% CI 1.53 to 7.94) and by counsellors (RR 1.27; 95% CI 1.12 to 1.43), and when it was conducted in longer sessions (more than 20 minutes per session) (RR 1.31; 95% CI 1.16 to 1.49). Multiple session treatments may be slightly more effective than single sessions, but both regimens produced positive outcomes. Evidence is unclear at present on the optimal number of follow-up calls.

There was variation across the trials in treatment fidelity. All trials used some variant of motivational interviewing.Critical details in how it was modified for the particular study population, the training of therapists and the content of the counselling were sometimes lacking from trial reports.  

Authors' conclusions

Motivational interviewing may assist smokers to quit. However, the results should be interpreted with caution due to variations in study quality, treatment fidelity and the possibility of publication or selective reporting bias. 

 

Plain language summary

Does motivational Interviewing help people who smoke to quit?

Motivational interviewing or its variants are widely used to help people stop smoking. It is a counselling technique for helping people to explore and resolve their uncertainties about changing their behaviour. It seeks to avoid an aggressive or confrontational approach. It tries to steer people towards choosing to change their behaviour, and to encourage their self-belief. Our review found that motivational interviewing seems to be effective when given by general practitioners and by trained counsellors. Longer sessions (more than 20 minutes per session) were more effective than shorter ones. Two or more sessions of treatment appeared to be marginally more successful than a single session treatment, but both delivered successful outcomes. The evidence for the value of follow-up telephone support was unclear. Our results should be interpreted with caution, due to variations in how the treatment was delivered, what it included and the completeness of the evidence.

 

摘要

背景

戒菸的動機式晤談

動機式晤談是一個個案中心導向的諮商模式，其設計是要幫助人們探索並解決行為改變時的矛盾感覺。它被發展成為酒精濫用的治療模式，但也可以用來幫助癮君子順利地戒菸。

目標

確定在促進戒菸上，動機式晤談的有效性。

搜尋策略

我們查詢了Cochrane Tobacco Addiction Group Specialized Register ，以相 關的詞語(motivational OR motivation OR motivating OR motivate OR behavi∗ OR motivat∗) and (interview∗ OR session∗ OR counsel∗ OR practi∗)查詢了主題或摘要，或是關鍵字。最近搜尋的日期是2009年4月。

選擇標準

提供給癮君子促使戒菸的動機式晤談或其變更型態的隨機試驗研究

資料收集與分析

我們抽取數據並做副本。主要結果在於測量禁菸後六個月的追蹤。在每一個研究中，我們使用最嚴格的戒菸定義，以及可取得的生化值的有效比率。在追蹤期流失的個案則被視為持續抽菸者。我們執行後設分析，以固定效果的MantelHaenszel模式進行分析。

主要結論

我們確定了14項發表在1997年和2008年的研究，包涵了超過1萬名抽菸者。研究進行1 – 4回合，每一回合15 – 45分鐘不等。有兩個研究以電話聯繫給予支持，並提供自助手冊與諮詢。一般而言研究中動機式晤談(MI)會與短期指導或一般護理做比較。由第一線醫療人員，醫療臨床工作人員，護士或諮商人員進行介入。後設分析MI與短期指導或一般護理，顯示出些許但顯著地增加戒菸率(RR 1.27; 95% CI 1.14 to 1.42)。小組分析顯示由第一線醫療人員(RR 3.49; 95% CI 1.53 to 7.94)，還有諮商人員(RR 1.27; 95% CI 1.12 to 1.43)進行的MI是有效的。多次治療回合比單次治療稍微有效，兩種療程都有正向的結果。目前在追蹤電話的最佳數量方面的證據並不清楚。在各個研究的治療精確性方面有變異性。所有的研究採用了一些動機式晤談的變形。關鍵性的細節在於如何被修正到符合特殊的研究族群，治療者的訓練，以及諮詢的內容，這些在研究報告內容上通常是缺乏描述的。

作者結論

動機式晤談可協助癮君子戒菸。然而，由於研究的品質的差異性，治療的準確性與 出版或選擇性報告的偏差，其結果應謹慎解釋。

翻譯人

本摘要由彰化基督教醫院陳美貴翻譯。

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

總結

動機式晤談能夠幫助癮君子戒菸嗎？ 動機式晤談或它的變形被廣泛用來幫助人們戒菸。這是一個諮詢技術，在人們不確定是不是要改變行為時，幫助他們探索和解決。它的目的是避免攻擊性或面質性的方式。它試圖引導人們對改變他們的行為做選擇，並鼓勵他們的自我信念。我們的回顧發現，由一般開業醫師與受過訓練的諮商者所進行的動機式晤談似乎是有效的 。較長節次(每一回合超過20分鐘)比短的更有效。兩個或以上的治療回合似乎比單次治療的成功率稍微多一點，但兩者都有有成功的結果。沒有清楚的證據顯示電話追蹤支持的價值。我們的結果應謹慎解釋，因為治療如何提供，它含括的內容，以及完整性的證據等方面是有差異的。