Multicentric randomized clinical trial to evaluate the long-term effectiveness of a motivational intervention against smoking, based on the information obtained from spirometry in primary care: the RESET study protocol

Francisco Martin-Lujan, Antoni Santigosa-Ayala, Josep-Lluis Piñol-Moreso, Mar Sorli-Aguilar, Gemma Flores-Mateo, Jordi Bladé-Creixenti, Josep Basora-Gallisà, Rosa Sola-Alberich, RESET Study Group investigators, D Borras-Vicente, F Gomez-Santidrian, M Grive-Isern, D Jovani-Puig, M T Juncosa-Cabré, M T Martinez-Perez, N Sarra-Manetas, E Aragones-Benaiges, S Exposito-Ribau, E Ferrer-Sorribas, S Folch-Pujol, M Fores-Palacios, P Perez-Layarra, F Buj-Visiedo, I Gallego-Arteaga, N Guinjoan-Aymemi, A Poca-Pastor, M Vila-Molet, M T Canela-Armengol, J Daniel-Diez, I Farre-Torra, M Garcia-Olive, M D Gil-Sanchez, C Senosiain-Yerno, R Vila-Ruiz, M J Andres-Pablo, J M Hernandez-Anguera, A M Lara-Pedrosa, T Lara-Pedrosa, M Lluís-Burgueño, M Mengual-Miralles, L Pelleja-Pellicer, R Rodriguez-Perez, M Rodríguez-Miguélez, M Sabate-Margalef, R Subirats-Segarra, N Allende-Muntane, T Aviño-Llopis, M Boira-Costa, C Delgado-Azuara, M Garcia-Vaque, S Loran-Valcarcel, T Sangra-Rodes, E Alvarez-Soler, M T Basora-Gallisa, J Blade-Creixenti, J Breva-Aymerich, A Caballero-Alias, A DelPozo-Niubo, N Martin-Vergara, A Vinuesa-Fernandez, M G Aguirre-Alava, S Crispi-Cifuentes, Y Fernandez-Pages, A Garcia-Uriarte, R Solis-Narvaez, R Caro-Garduño, C Cortes-Ponce, C Ferrer-Marin, T Llauradó-Sabaté, M Llauradó-Vernet, P Llobet-Azpitarte, C Mangrane-Guillen, G Muñoz-Alvarez, M A Oliver-Esteve, F París-Pallejà, M Ricart-Sancho, E Rivera-Manrique, A Salva-Brusel, M Soler-Pont, M Timon-Torres, M Boldú-Ortega, G Elizalde-Río, C GarciaTalarn, M Gorgues-Espasa, A Güell-Coll, C Hernandez-Nuñez, M A Naranjo-Orihuela, A Odena-Estrade, I Palou-Vall, L Panadès-Baldrich, A Ribé-Miró, Y Ortega-Vila, I Pascual-Palacios, X Perez-Cuit, M Rodrigo-Gotor, M Aliseda-Tienza, C Anguera-Perpiña, J Boj-Casajuana, J J Cabré-Vila, C Chancho-Rodriguez, S Dalmau-Vidal, M Español-Pons, M García-Barco, R Gonzalez, Perez, M Huguet-Jacob, A Isach-Subirana, E Martí-Suau, M Munté-Bigorra, M Nolla-Mallafre, J Pardo-Andújar, R Pedret-Llaberia, L Peralta-Encinas, P Preixens, Vallinoto, E Ras-Vidal, C Rubio-Gascon, A Reche-Martinez, R Sagarra-Alamo, M Sanchez-Marin, M I Sanchez-Oro, A R Silva-Orjuela, J Vizcaíno-Marin, L Augé-Garcia, A I Castelao-Alvarez, F Calamote-Manso, L Clotas-Sancho, J Ferre-Gras, M Gasull-Gomis, A Gonzalez-Garces, S Gonzalez-Gonzalo, A Llano-Sanchez, E Nevot-Bueno, E Ruiz-Morcillo, M S delAmo-Benito, E Guijarro-Tapia, A J Lopez-Barea, A Manresa, I Marsà-Gimènez, R Moreno-Ramon, N Nievas-Diaz, M Prieto-Cid, M Pujol-Porquera, C Toledo-Peinado, M L Barrera-Uriarte, E J Borreguero-Guerrero, M P Castell-Montrull, R E Catalin, P CentellesVelilla, J Ferre-Rey, M J Forcadell-Peris, C M Fuentes-Bellido, O Garcia-Gimeno, R Landin-Delgado, J Ledo-Garcia, E Satue-Gracia, O Briones-Carcedo, C Rambla-Vidal, J Robuste-Ingles, O E Arago-Albalate, V R Arnau-Adan, E N Balcells-Gonzalez, A Boada-Tous, G Cando-Guasch, J Casajuana-Brunet, J Castellvi-Baldira, R Girona-Real, M C Grau-Perez, M Medina-Clemente, A Moreno-Lagunas, M C Moreno-Ortiz, E Pay-Caro, A M Prats-Caellas, R Profitos-Amiell, F Rodriguez-Alonso, F J Sobrino-Perez, P Sole-Barreras, M L Villaroya-Bullido, Francisco Martin-Lujan, Antoni Santigosa-Ayala, Josep-Lluis Piñol-Moreso, Mar Sorli-Aguilar, Gemma Flores-Mateo, Jordi Bladé-Creixenti, Josep Basora-Gallisà, Rosa Sola-Alberich, RESET Study Group investigators, D Borras-Vicente, F Gomez-Santidrian, M Grive-Isern, D Jovani-Puig, M T Juncosa-Cabré, M T Martinez-Perez, N Sarra-Manetas, E Aragones-Benaiges, S Exposito-Ribau, E Ferrer-Sorribas, S Folch-Pujol, M Fores-Palacios, P Perez-Layarra, F Buj-Visiedo, I Gallego-Arteaga, N Guinjoan-Aymemi, A Poca-Pastor, M Vila-Molet, M T Canela-Armengol, J Daniel-Diez, I Farre-Torra, M Garcia-Olive, M D Gil-Sanchez, C Senosiain-Yerno, R Vila-Ruiz, M J Andres-Pablo, J M Hernandez-Anguera, A M Lara-Pedrosa, T Lara-Pedrosa, M Lluís-Burgueño, M Mengual-Miralles, L Pelleja-Pellicer, R Rodriguez-Perez, M Rodríguez-Miguélez, M Sabate-Margalef, R Subirats-Segarra, N Allende-Muntane, T Aviño-Llopis, M Boira-Costa, C Delgado-Azuara, M Garcia-Vaque, S Loran-Valcarcel, T Sangra-Rodes, E Alvarez-Soler, M T Basora-Gallisa, J Blade-Creixenti, J Breva-Aymerich, A Caballero-Alias, A DelPozo-Niubo, N Martin-Vergara, A Vinuesa-Fernandez, M G Aguirre-Alava, S Crispi-Cifuentes, Y Fernandez-Pages, A Garcia-Uriarte, R Solis-Narvaez, R Caro-Garduño, C Cortes-Ponce, C Ferrer-Marin, T Llauradó-Sabaté, M Llauradó-Vernet, P Llobet-Azpitarte, C Mangrane-Guillen, G Muñoz-Alvarez, M A Oliver-Esteve, F París-Pallejà, M Ricart-Sancho, E Rivera-Manrique, A Salva-Brusel, M Soler-Pont, M Timon-Torres, M Boldú-Ortega, G Elizalde-Río, C GarciaTalarn, M Gorgues-Espasa, A Güell-Coll, C Hernandez-Nuñez, M A Naranjo-Orihuela, A Odena-Estrade, I Palou-Vall, L Panadès-Baldrich, A Ribé-Miró, Y Ortega-Vila, I Pascual-Palacios, X Perez-Cuit, M Rodrigo-Gotor, M Aliseda-Tienza, C Anguera-Perpiña, J Boj-Casajuana, J J Cabré-Vila, C Chancho-Rodriguez, S Dalmau-Vidal, M Español-Pons, M García-Barco, R Gonzalez, Perez, M Huguet-Jacob, A Isach-Subirana, E Martí-Suau, M Munté-Bigorra, M Nolla-Mallafre, J Pardo-Andújar, R Pedret-Llaberia, L Peralta-Encinas, P Preixens, Vallinoto, E Ras-Vidal, C Rubio-Gascon, A Reche-Martinez, R Sagarra-Alamo, M Sanchez-Marin, M I Sanchez-Oro, A R Silva-Orjuela, J Vizcaíno-Marin, L Augé-Garcia, A I Castelao-Alvarez, F Calamote-Manso, L Clotas-Sancho, J Ferre-Gras, M Gasull-Gomis, A Gonzalez-Garces, S Gonzalez-Gonzalo, A Llano-Sanchez, E Nevot-Bueno, E Ruiz-Morcillo, M S delAmo-Benito, E Guijarro-Tapia, A J Lopez-Barea, A Manresa, I Marsà-Gimènez, R Moreno-Ramon, N Nievas-Diaz, M Prieto-Cid, M Pujol-Porquera, C Toledo-Peinado, M L Barrera-Uriarte, E J Borreguero-Guerrero, M P Castell-Montrull, R E Catalin, P CentellesVelilla, J Ferre-Rey, M J Forcadell-Peris, C M Fuentes-Bellido, O Garcia-Gimeno, R Landin-Delgado, J Ledo-Garcia, E Satue-Gracia, O Briones-Carcedo, C Rambla-Vidal, J Robuste-Ingles, O E Arago-Albalate, V R Arnau-Adan, E N Balcells-Gonzalez, A Boada-Tous, G Cando-Guasch, J Casajuana-Brunet, J Castellvi-Baldira, R Girona-Real, M C Grau-Perez, M Medina-Clemente, A Moreno-Lagunas, M C Moreno-Ortiz, E Pay-Caro, A M Prats-Caellas, R Profitos-Amiell, F Rodriguez-Alonso, F J Sobrino-Perez, P Sole-Barreras, M L Villaroya-Bullido

Abstract

Background: Spirometry is the recommended method of evaluating pulmonary function when respiratory disease is suspected in smokers. Nonetheless, no evidence exists of the usefulness of information obtained from this test as a motivational strategy for smoking cessation. The primary objective of this study is to evaluate the effectiveness of a motivational intervention based on spirometry results in achieving long-term smoking cessation.

Methods/design: We propose a multicenter randomized clinical trial in the primary care setting.

Study subjects: We will recruit active smokers of both sexes, aged 35-70 years, with a cumulated smoking habit exceeding 10 packs/year and who consult for any reason with their primary care physician in the 20 health centers in the province of Tarragona (Spain). Patients with a history of lung disease or who have undergone exploratory measures of pulmonary function in the preceding 12 months will be excluded. All patients who agree to participate will provide signed informed consent prior to their inclusion. A total of 1000 smokers will be consecutively randomized to a control or intervention group (1:1).

Intervention: Participants in both groups will receive brief (5-minute) health counseling, in accordance with usual clinical practice. In a consultation lasting about 15 minutes, participants in the intervention group will also receive detailed, personalized information about the results of a spirometry test and about their lung age compared with their chronological age. Both groups will be followed up for 12 months. Main variables and analysis: The main variable will be sustained smoking abstinence at 12 months after the intervention, as confirmed by CO breath testing and urine cotinine test. Results will be analyzed based on intention to treat, using the chi-square test and logistical regression if necessary to adjust for confounding variables.

Discussion: We expect the rate of prolonged smoking abstinence in the intervention group will be at least 5% higher than in the control group. If this strategy proves effective, it could easily be included in the health promotion activities offered in primary care settings.

Trial registration: ClinicalTrials.gov Identifier: NCT02153047 . Registered on 28/05/2014.

Figures

Fig. 1
Fig. 1
Diagram of the RESET study: process of selection, randomization and follow-up of subjects included in the study

References

    1. Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. Am J Prev Med. 2008;35:158–176. doi: 10.1016/j.amepre.2008.04.009.
    1. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004;328:1519–1533. doi: 10.1136/.
    1. Ministerio de Sanidad y Consumo. Plan de Calidad para el sistema Nacional de Salud. Estrategia en EPOC del Sistema Nacional de Salud. Sanidad 2009. Ministerio de Sanidad y Política Social. Available at: .
    1. AHRQ. Agency for Healthcare Research and Quality (US) The Guide to Clinical Preventive Services 2014: Recommendations of the U.S. Preventive Services Task Force. Rockville: Agency for Healthcare Research and Quality (US); 2014.
    1. Fiore MC, Baker TB. Clinical practice. Treating smokers in the health care setting. N Engl J Med. 2011;365:1222–1231. doi: 10.1056/NEJMcp1101512.
    1. CNPT. Comité Nacional para la Prevención del Tabaquismo. Encuesta sobre conocimientos, actitudes, creencias y conductas en relación al consumo de tabaco. Madrid 2008. Available at:
    1. Whitlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med. 2002;22:267–284. doi: 10.1016/S0749-3797(02)00415-4.
    1. Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction. 2004;99:29–38. doi: 10.1111/j.1360-0443.2004.00540.x.
    1. Young RP, Hopkins RJ, Smith M, Hogarth DK. Smoking cessation: the potential role of risk assessment tools as motivational triggers. Postgrad Med J. 2010;86:26–33. doi: 10.1136/pgmj.2009.084947.
    1. McCaul KD, Hockemeyer JR, Johnson RJ, Zetocha K, Quinlan K, Glasgow RE. Motivation to quit using cigarettes: a review. Addict Behav. 2006;31:42–56. doi: 10.1016/j.addbeh.2005.04.004.
    1. Kaleta D, Korytkowski PA, Makowiec-Dabrowska T, Usidame B, Bak-Romaniszyn L, Fronczak A. Predictors of long-term smoking cessation: Results from the global adult tobacco survey in Poland (2009-2010) BMC Public Health. 2012;12:1020. doi: 10.1186/1471-2458-12-1020.
    1. Taylor KL, Cox LS, Zincke N, Mehta L, McGuire C, Gelmann E. Lung cancer screening as a teachable moment for smoking cessation. Lung Cancer. 2007;56:125–134. doi: 10.1016/j.lungcan.2006.11.015.
    1. McBride CM, Emmons KM, Lipkus IM. Understanding the potential of teachable moments: the case of smoking cessation. Health Educ Res. 2003;18:156–170. doi: 10.1093/her/18.2.156.
    1. Bize R, Cornuz J. Incentives to quit smoking in primary care. BMJ. 2008;336:567–568. doi: 10.1136/bmj.39506.386759.80.
    1. Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187:347–365. doi: 10.1164/rccm.201204-0596PP.
    1. Gorecka D, Bednarek M, Nowinski A, Puscisnska E, Goljan-Geremek A, Zielinski J. Diagnosis of airflow limitation combined with smoking cessation advice increases stop smoking rate. Chest. 2003;123:1916–1923. doi: 10.1378/chest.123.6.1916.
    1. Young RP, Hopkins R, Eaton TE. Forced expiratory volume in one second: not just lung function test but a marker of premature death from all causes. Eur Respir J. 2007;30:616–622. doi: 10.1183/09031936.00021707.
    1. Peters EN, Hughes JR, Callas PW, Solomon LJ. Goals indicate motivation to quit smoking. Addiction. 2007;102:1158–1163. doi: 10.1111/j.1360-0443.2007.01870.x.
    1. Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE for the Lung Health Study Research Group The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality. A Randomized Clinical Trial. Ann Intern Med. 2005;142:233–239. doi: 10.7326/0003-4819-142-4-200502150-00005.
    1. U.S. Preventive Services Task Force Screening for chronic 2 obstructive pulmonary disease using spirometry: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;148:529–534. doi: 10.7326/0003-4819-148-7-200804010-00212.
    1. Segnan N, Ponti A, Battista RN, Senore C, Rosso S, Shapiro SH, et al. A randomized trial of smoking cessation interventions in general practice in Italy. Cancer Causes Control. 1991;2:239–246. doi: 10.1007/BF00052140.
    1. Buffels J, Degryse J, Decramer M, Heyrman J. Spirometry and smoking cessation advice in general practice: a randomised clinical trial. Respir Med. 2006;100:2012–2017. doi: 10.1016/j.rmed.2006.02.014.
    1. Parkes G, Greenhalgh T, Griffin M, Dent R. Effect of smoking on quit rate of telling patients their lung age: The Step2quit randomized controlled trial. BMJ. 2008;336:598–600. doi: 10.1136/bmj.39503.582396.25.
    1. Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev. 2013;5:CD000165.
    1. Bize R, Burnand B, Mueller Y, Rège-Walther M, Camain JY, Cornuz J. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database Syst Rev. 2012;12:CD004705.
    1. Rodriguez-Alvarez M, Toran-Monserrat P, Munoz-Ortiz L, Negrete-Palma A, Montero-Alia JJ, Jimenez-Gonzalez M, et al. Effectiveness of regular reporting of spirometric results combined with a smoking cessation advice by a primary care physician on smoking quit rate in adult smokers: a randomized controlled trial. ESPIROTAB study. BMC Fam Pract. 2011;12:61. doi: 10.1186/1471-2296-12-61.
    1. Martin-Lujan F, Piñol-Moreso JL, Martin-Vergara N, Basora-Gallisa J, Pascual-Palacios I, Sagarra-Alamo R, et al. Effectiveness of a structured motivational intervention including smoking cessation advice and spirometry information in the primary care setting: the ESPITAP study. BMC Public Health. 2011;11:859. doi: 10.1186/1471-2458-11-859.
    1. Lin KW. Lung age: Study’s conclusion about screening is unwarranted. BMJ. 2008;336:1034. doi: 10.1136/bmj.39556.492176.80.
    1. Heatherton TF, Kozlowski LT, Frecker RC, Fageström KO. The Fagerström test for nicotine dependence: a revision of the Fagerström tolerance questionnaire. Br J Addict. 1991;86:1119–1127. doi: 10.1111/j.1360-0443.1991.tb01879.x.
    1. Richmond RL, Kehoe LA, Webster IW. Multivariate models for predicting abstention following intervention to stop smoking by general practitioners. Addiction. 1993;88:1127–1135. doi: 10.1111/j.1360-0443.1993.tb02132.x.
    1. Prochaska J, DiClemente C. Stages and process of self-change of smoking: towards and integrative model of change. J Consult Clin Psychol. 1983;51:390–395. doi: 10.1037/0022-006X.51.3.390.
    1. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–338. doi: 10.1183/09031936.05.00034805.
    1. Fletcher C, Peto R. The natural history of chronic airflow obstruction. BMJ. 1977;1:1645–1648. doi: 10.1136/bmj.1.6077.1645.
    1. Morris JF, Temple W. Spirometric “lung age” estimation for motivating smoking cessation. Prev Med. 1985;14:655–662. doi: 10.1016/0091-7435(85)90085-4.
    1. Hughes J, Keely J, Niaura R, Ossip-Klein D, Richmond R, Swan G. Measures of abstinence in clinical trials: issues and recommendations. Nicotine Tob Res. 2003;5:13–26. doi: 10.1080/1462220031000070552.
    1. SRNT Subcommittee on Biochemical Verification Biochemical verification of tobacco use and cessation. Nicotine Tob Reser. 2002;4:149–159. doi: 10.1080/14622200210123581.
    1. Akl EA, Briel M, You JJ, Lamontagne F, Gangji A, Cukierman-Yaffe T, et al. LOST to follow-up Information in Trials (LOST-IT): a protocol on the potential impact. Trials. 2009;10:40. doi: 10.1186/1745-6215-10-40.
    1. Caponnetto P, Polosa R. Common predictors of smoking cessation in clinical practice. Respir Med. 2008;102:1182–1192. doi: 10.1016/j.rmed.2008.02.017.
    1. West R. ABC of smoking cessation: assessment of dependence and motivation to stop smoking. BMJ. 2004;328:338–339. doi: 10.1136/bmj.328.7435.338.
    1. Bucher HC, Griffith LE, Guyatt GH. Systematic review on the risk and benefit of different cholesterol-lowering interventions. Arterioscler, Thromb, Vasc Biol. 1999;19:187–195. doi: 10.1161/01.ATV.19.2.187.
    1. Bovet P, Perret F, Cornuz J, Quilindo J, Paccaud F. Improved smoking cessation in smokers given ultrasound photographs of their own atherosclerotic plaques. Prev Med. 2002;34:215–220. doi: 10.1006/pmed.2001.0976.
    1. Lin K, Watkins B, Johnson T, Rodriguez JA, Barton MB, U.S. Preventive Services Task Force Screening for chronic obstructive pulmonary disease using spirometry: summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;148:535–543. doi: 10.7326/0003-4819-148-7-200804010-00213.
    1. Kotz D, Wesseling G, Huibers MJ, van Schayck OC. Efficacy of confronting smokers with airflow limitation for smoking cessation. Eur Respir J. 2009;33:754–762. doi: 10.1183/09031936.00116308.
    1. Kotz D, Vos R, Huibers MJ. Ethical analysis of the justifiability of labelling with COPD for smoking cessation. J Med Ethics. 2009;35:534–540. doi: 10.1136/jme.2009.029280.

Source: PubMed

3
Abonnieren