Effectiveness of a Telephone-Based Motivational Intervention for Smoking Cessation in Patients With Crohn Disease: A Randomized, Open-Label, Controlled Clinical Trial

Ester Navarro Correal, Francesc Casellas Jorda, Natalia Borruel Sainz, Virginia Robles Alonso, Claudia Herrera de Guise, Arantxa Ibarz Casas, Josep Maria Sánchez García, Genoveva Vila Morte, Carmen Fuentelsaz Gallego, Ester Navarro Correal, Francesc Casellas Jorda, Natalia Borruel Sainz, Virginia Robles Alonso, Claudia Herrera de Guise, Arantxa Ibarz Casas, Josep Maria Sánchez García, Genoveva Vila Morte, Carmen Fuentelsaz Gallego

Abstract

A randomized, open-label, controlled clinical trial was designed to assess the effectiveness of a motivational intervention based on the 5 R's model (relevance, risks, rewards, roadblocks, and repetition) delivered by specialized inflammatory bowel disease nurses every 3 months over a 1-year period as compared with patients who were followed regularly. Patients diagnosed with Crohn disease, aged 18 years or older, who reported being active smokers with Internet access at home and an e-mail address were eligible. A total of 144 patients (72 per group) were included (50% women, median age 40 years). They smoked a median of 10 cigarettes per day (range = 1-40) and had been smoking for a median of 22 years (range = 1-51). Motivation to quit (Richmond test) was low in 73 patients, moderate in 39 patients, and high in 32 patients. Statistically significant differences between the study groups in the predisposition to change, motivation to quit, and tobacco withdrawal were not found. However, 14 patients (20.9%) in the intervention group and 9 patients (13.2%) among controls stopped smoking at the end of the study. These findings support a higher trend toward smoking cessation associated with the motivational intervention 5 R's. This behavioral strategy can aid patients with Crohn disease to quit smoking.

Trial registration: ClinicalTrials.gov NCT04225403.

Conflict of interest statement

Conflicts of Interest: None to be disclosed.

Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Gastroenterology Nurses and Associates.

Figures

FIGURE 1.
FIGURE 1.
Flowchart of the study population.

References

    1. Agency for Healthcare Research and Quality. (2012, December). Patients not ready to make a quit attempt now (the “5 R's”). Rockville, MD: Author. Retrieved March 28, 2020, from
    1. Ananthakrishnan A. N., Kaplan G. G., Ng S. C. (2020). Changing global epidemiology of inflammatory bowel diseases: Sustaining health care delivery into the 21st century. Clinical Gastroenterology and Hepatology, 18(6), 1252–1260. doi:10.1016/j.cgh.2020.01.028
    1. Biedermann L., Fournier N., Misselwitz B., Frei P., Zeit J., Manser C. N., ... Swiss Inflammatory Bowel Disease Cohort Study Group. (2015). High rates of smoking especially in female Crohn's disease patients and low use of supportive measures to achieve smoking cessation—Data from the Swiss IBD Cohort Study. Journal of Crohn's and Colitis, 9(10), 819–829.
    1. Correal E. N., Leiva O. B., Galguera A. D., Barrero M. G., Pastor E. S., Gonzalo M. F. M. (2019). Nurse-led telephone advice line for patients with inflammatory bowel disease: A cross-sectional multicenter activity analysis. Gastroenterology Nursing, 42(2), 132–139.
    1. Cosnes J., Beaugerie L., Carbonnel F., Gendre J. P. (2001). Smoking cessation and the course of Crohn's disease: An intervention study. Gastroenterology, 120(5), 1093–1099.
    1. Cosnes J., Carbonnel F., Carrat F., Beaugerie L., Cattan S., Gendre J. (1999). Effects of current and former cigarette smoking on the clinical course of Crohn's disease. Alimentary Pharmacology and Therapeutics, 13(11), 1403–1411.
    1. Dam A. N., Berg A. M., Farraye F. A. (2013). Environmental influences on the onset and clinical course of Crohn's disease—Part 1: An overview of external risk factors. Gastroenterology & Hepatology, 9(11), 711–717.
    1. De Bie C., Ballet V., Hendriks N., Coenen S., Weyts E., Van Assche G., Ferrante M. (2015). Smoking behaviour and knowledge of the health effects of smoking in patients with inflammatory bowel disease. Alimentary Pharmacology and Therapeutics, 42(11–12), 1294–1302.
    1. Ducharme-Bénard S., Côté-Daigneault J., Lemoyne M., Orlicka K., Lahaie R., Weber A., Bouin M. (2016). Patients with inflammatory bowel disease are unaware of the impact of smoking on their disease. Journal of Clinical Gastroenterology, 50(6), 490–497.
    1. Etter J. F., Duc T. V., Perneger T. V. (1999). Validity of the Fagerström test for nicotine dependence and of the Heaviness of Smoking Index among relatively light smokers. Addiction, 94(2), 269–281.
    1. GBD 2017 Inflammatory Bowel Disease Collaborators. (2020). The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet Gastroenterology & Hepatology, 51(1), 17–30.
    1. Hilsden R. J., Hodgins D. C., Timmer A., Sutherland L. R. (2000). Helping patients with Crohn's disease quit smoking. American Journal of Gastroenterology, 95(2), 352–358.
    1. Jairath V., Feagan B. G. (2020). Global burden of inflammatory bowel disease. The Lancet, 5(1), 2–3.
    1. Johnson G. J., Cosnes J., Mansfield J. C. (2005). Review article: Smoking cessation as primary therapy to modify the course of Crohn's disease. Alimentary Pharmacology and Therapeutics, 21(8):921–931.
    1. Kennelly R. P., Subramaniam T., Egan L. J., Joyce M. R. (2013). Smoking and Crohn's disease: Active modification on an independent risk factor (Education alone is not enough). Journal of Crohn's and Colitis, 7(8), 631–635.
    1. Leung Y., Kaplan G. G., Rioux K. P., Hubbard J., Kamhawi S., Stasiak L., Rubin D. T. (2012). Assessment of variables associated with smoking cessation in Crohn's disease. Digestive Diseases and Sciences, 57(4), 1026–1032.
    1. Mahid S. S., Minor K. S., Soto R. E., Hornung C. A., Galandiuk S. (2006). Smoking and inflammatory bowel disease: A meta-analysis. Mayo Clinic Proceedings, 81(11):1462–1471.
    1. Matsuoka K., Kobayashi T., Ueno F., Matsui T., Hirai F., Inoue N., Shimosegawa T. (2018). Evidence-based clinical practice guidelines for inflammatory bowel disease. Journal of Gastroenterology, 53(3), 305–353.
    1. Nulsen B., Sands B. E., Shah B. J., Ungaro R. C. (2018). Practices, attitudes, and knowledge about Crohn's disease and smoking cessation among gastroenterologists. European Journal of Gastroenterology and Hepatology, 30(2), 155–160.
    1. Nunes T., Etchevers M. J., Merino O., Gallego S., García-Sánchez V., Marín-Jiménez M., ... TABACROHN Study Group of GETECCU. (2013). High smoking cessation rate in Crohn's disease patients after physician advice—The TABACROHN Study. Journal of Crohn's and Colitis, 7(3), 202–207.
    1. Parkes G. C., Whelan K., Lindsay J. O. (2014). Smoking in inflammatory bowel disease: Impact on disease course and insights into the aetiology of its effect. Journal of Crohn's and Colitis, 8(8), 717–725.
    1. Prochaska J. O., DiClemente C. C., Velicer W. F., Ginpil S., Norcross J. C. (1985). Predicting change in smoking status for self-changers. Addictive Behaviors, 10(4), 395–406.
    1. Reese G. E., Nanidis T., Borysiewicz C., Yamamoto T., Orchard T., Tekkis P. P. (2008). The effect of smoking after surgery for Crohn's disease: A meta-analysis of observational studies. International Journal of Colorectal Disease, 23(12), 1213–1221.
    1. Richmond R. L., Kehoe L. A., Webster I. W. (1993). Multivariate models for predicting abstention following intervention to stop smoking by general practitioners. Addiction, 88(8), 1127–1135.
    1. Rodríguez Calero M. Á., Villafáfila Gomila C. J., Sastre Fullana P. (2019). Advanced practice nurses and evidence-based practice. An opportunity for change. Enfermería Clínica, 29(2), 119–124.
    1. Silverberg M. S., Satsangi J., Ahmad T., Arnott I. D., Bernstein C. N., Brant S. R., Warren B. F. (2005). Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Canadian Journal of Gastroenterology, 19(Suppl. A), 5A–36A.
    1. Stead L. F., Hartmann-Boyce J., Perera R., Lancaster T. (2013). Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews, (8), CD002850.
    1. To N., Grace D. J., Ford A. C. (2016). Systematic review with meta-analysis: The adverse effects of tobacco smoking on the natural history of Crohn's disease. Alimentary Pharmacology and Therapeutics, 43(5), 549–561.
    1. van der Heide F., Dijkstra A., Albersnagel F. A., Kleibeuker J. H., Dijkstra G. (2010). Active and passive smoking behaviour and cessation plans of patients with Crohn's disease and ulcerative colitis. Journal of Crohn's and Colitis, 4(2), 125–131.
    1. Vegni E., Gilardi D., Bonovas S., Corrò B. E., Menichetti J., Leone D., Fiorino G. (2019). Illness perception in inflammatory bowel disease patients is different between patients with active disease or in remission: A prospective cohort study. Journal of Crohn's and Colitis, 13(4), 417–423.
    1. Windsor J. W., Kaplan G. G. (2019). Evolving epidemiology of IBD. Current Gastroenterology Reports, 21(8), 40. doi:10.1007/s11894-019-0705-6

Source: PubMed

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