Brief smoking cessation advice from practice nurses during routine cervical smear tests appointments: a cluster randomised controlled trial assessing feasibility, acceptability and potential effectiveness

S Hall, E Reid, O C Ukoumunne, J Weinman, T M Marteau, S Hall, E Reid, O C Ukoumunne, J Weinman, T M Marteau

Abstract

The aim of this study is to assess the potential effectiveness, acceptability and feasibility of a brief smoking cessation intervention delivered as part of cervical screening. A cluster randomised controlled trial was conducted with clinic week as the unit of randomisation, comparing a group (n=121) receiving brief smoking cessation advice supplemented with written information given by practice nurses during cervical smear test appointments, with a group (n=121) not receiving this advice. Outcomes were intention to stop smoking (potential effectiveness); intention to attend for future cervical screening (acceptability); duration of intervention (feasibility). 172/242 (71%) and 153/242 (63%) participants completed 2-week and 10-week follow-ups, respectively. Compared to women in the control group, those in the intervention group had higher intentions to stop smoking at 2-weeks (adjusted mean difference 0.51, 95% CI: -0.02 to 1.03, P=0.06) and 10-weeks (adjusted mean difference 0.80, 95% CI 0.10 to 1.50, P=0.03). The two groups had similarly high intentions to attend for future screening. Consultations in the intervention arm took a mean of 4.98 min (95% CI: 3.69 to 6.27; P<0.001) longer than the control arm. In conclusion, brief smoking cessation advice given by practice nurses as part of cervical screening seems acceptable, feasible and potentially effective. Evidence is lacking on the effectiveness and cost effectiveness of this intervention in achieving biochemically validated smoking cessation.

Figures

Figure 1
Figure 1
Movement of women through the study.

References

    1. Acladious NN, Sutton C, Mandal D, Hopkins R, Zaklama M, Kitchener H (2002) Persistent human papillomavirus and smoking increase risk of failure of treatment of Cervical Intraepithelial Neoplasia (CIN). Int J Cancer 98: 435–439
    1. Armitage CJ, Connor M (2001) Efficacy of the theory of planned behaviour: a meta-analytic review. B J Soc Psychol 40: 471–499
    1. Bishop AJ, Marteau TM, Hall S, Kitchener H, Hajek P (2005) Increasing women's intentions to stop smoking following an abnormal cervical smear test result. Prev Med 45: 179–185
    1. Butler CC, Pill R, Stott NCH (1998) Qualitative study of patients' perceptions of doctors' advice to quit smoking: implications for opportunistic health promotion. BMJ 316: 1878–1881
    1. Clark MA, Rakowski W, Ehrich B (2000) Breast and cervical cancer screening: associations with personal, spouse's and combined smoking status. Cancer Epidemiol Biomarkers Preven 9: 513–516
    1. Cohen J (1988) Statistical Power Analysis for the Behavioral Sciences 2nd edn, New York: Academic Press
    1. Davison AC, Hinkley DV (1997) Bootstrap Methods and their Application. Cambridge: Cambridge University Press
    1. Department of Health (2001) The Expert Patient: A New Approach to Chronic Disease Management for the 21st Century. London: Crown Copyright
    1. Donner A, Klar N (2000) Design and Analysis of Cluster Randomization Trials in Health Research. London: Arnold
    1. Goldstein H (1995) Multilevel Statistical Models. London: Arnold
    1. Hall S, Bishop A, Marteau TM (2003) Motivating smoking cessation in women undergoing cervical screening: evaluation of two leaflets. Nicotine Tob Res 5: 1–6
    1. Hall S, Weinman J, Marteau TM (2004) The motivating impact of informing women of a link between smoking and cervical cancer: the role of coherence. Health Psychol 23: 419–424
    1. International Agency for Research on Cancer (2004) Research in the behavioural sciences to improve cancer control and care: a strategy for development. Eur J Cancer 40: 316–325
    1. Lancaster T, Stead LF (2004) Physician advice for smoking cessation. In Cochrane Library Issue 4 Oxford: Update Software
    1. Lancaster T, Stead LF (2005) Self-help interventions for smoking cessation. In Cochrane Library Issue 3 Oxford: Update Software
    1. Marteau TM, Rana S, Kubba A (2002) Smoking and cervical cancer: a qualitative study of the explanatory models of smokers with cervical abnormalities. Psychology, Health Med 7: 107–109
    1. McColl E, Jacoby A, Thomas L, Soutter J, Bamford T, Steen N, Thomas R, Harvey E, Garratt A, Bond J (2001) Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients. Health Technol Assess 5: 31
    1. Medical Research Council (2000) A Framework for Development and Evaluation of RCTs for Complex Interventions to Improve Health. London: Medical Research Council
    1. Medical Research Council (2002) Cluster Randomised Trials: Methodological and Ethical Considerations. MRC Clinical Trials Series. London: Medical Research Council
    1. National Institute for Clinical Excellence (2006) Brief Interventions and Referral for Smoking Cessation in Primary Care and Other Settings NICE Public Health Intervention Guidance No. 1
    1. Orbell S, Crombie I, Robertson A, Johnston G, Kenicer M (1995) Assessing the effectiveness of a screening campaign: who is missed by 80% cervical screening coverage? J R Soc Med 88: 389–394
    1. Patnick J (ed) (2003) NHS Cervical Screening Programme: Celebrating 15 Years of Achievement. Sheffield, UK: NHS Cancer Screening Programmes
    1. Rice VH, Stead LF (2004) Nursing interventions for smoking cessation. Cochrane Library Issue 2 Oxford: Update Software
    1. Roberts C, Torgerson D (1998) Randomisation methods in controlled trials. BMJ 317: 1301.
    1. Sheeran P, Orbell S (1998) Does intention predict condom use? A meta analysis and test of four moderators. B J Soc Psychol 37: 231–250
    1. StataCorp (2005) Stata Statistical Software: Release 9.2. College Station, TX: Stata Corporation
    1. Szarewski A, Cuzick J (1998) Smoking and cervical neoplasia: a review of the evidence. J Epidemiol Biostat 3: 229–256
    1. Szarewski A, Jarvis MJ, Sasieni P, Anderson M, Edwards R, Steele SJ, Guillebaud J, Cuzick J (1996) Effect of smoking cessation on cervical lesion size. Lancet 347: 941–943
    1. Ukoumunne OC, Gulliford MC, Chinn S, Sterne JAC, Burney PGJ, Donner A (1999) Methods in health service research: evaluation of health interventions at area and organisation level. BMJ 319: 376–379
    1. West R, McNeill A, Raw M (2000) Smoking cessation guidelines for health professionals. Thorax 55: 987–999
    1. World Health Organization (2003) World Cancer Report. Lyon: IARC Press

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe