Training health professionals in smoking cessation

Kristin V Carson, Marjolein E A Verbiest, Mathilde R Crone, Malcolm P Brinn, Adrian J Esterman, Willem J J Assendelft, Brian J Smith, Kristin V Carson, Marjolein E A Verbiest, Mathilde R Crone, Malcolm P Brinn, Adrian J Esterman, Willem J J Assendelft, Brian J Smith

Abstract

Background: Cigarette smoking is one of the leading causes of preventable death world wide. There is good evidence that brief interventions from health professionals can increase smoking cessation attempts. A number of trials have examined whether skills training for health professionals can lead them to have greater success in helping their patients who smoke.

Objectives: To determine the effectiveness of training health care professionals in the delivery of smoking cessation interventions to their patients, and to assess the additional effects of training characteristics such as intervention content, delivery method and intensity.

Search methods: The Cochrane Tobacco Addiction Group's Specialised Register, electronic databases and the bibliographies of identified studies were searched and raw data was requested from study authors where needed. Searches were updated in March 2012.

Selection criteria: Randomized trials in which the intervention was training of health care professionals in smoking cessation. Trials were considered if they reported outcomes for patient smoking at least six months after the intervention. Process outcomes needed to be reported, however trials that reported effects only on process outcomes and not smoking behaviour were excluded.

Data collection and analysis: Information relating to the characteristics of each included study for interventions, participants, outcomes and methods were extracted by two independent reviewers. Studies were combined in a meta-analysis where possible and reported in narrative synthesis in text and table.

Main results: Of seventeen included studies, thirteen found no evidence of an effect for continuous smoking abstinence following the intervention. Meta-analysis of 14 studies for point prevalence of smoking produced a statistically and clinically significant effect in favour of the intervention (OR 1.36, 95% CI 1.20 to 1.55, p= 0.004). Meta-analysis of eight studies that reported continuous abstinence was also statistically significant (OR 1.60, 95% CI 1.26 to 2.03, p= 0.03).Healthcare professionals who had received training were more likely to perform tasks of smoking cessation than untrained controls, including: asking patients to set a quit date (p< 0.0001), make follow-up appointments (p< 0.00001), counselling of smokers (p< 0.00001), provision of self-help material (p< 0.0001) and prescription of a quit date (p< 0.00001). No evidence of an effect was observed for the provision of nicotine gum/replacement therapy.

Authors' conclusions: Training health professionals to provide smoking cessation interventions had a measurable effect on the point prevalence of smoking, continuous abstinence and professional performance. The one exception was the provision of nicotine gum or replacement therapy, which did not differ between groups.

Conflict of interest statement

None known.

Figures

1
1
Study flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias judgement presented as percentages across all included studies
3
3
Forest plot of comparison: 1 The effect of training health professionals on patient smoking cessation
4
4
Funnel plot of comparison: 1 The effect of training health professionals on patient smoking cessation
1.1. Analysis
1.1. Analysis
Comparison 1 The effect of training health professionals on patient smoking cessation, Outcome 1 Smoking cessation at longest follow‐up.
1.2. Analysis
1.2. Analysis
Comparison 1 The effect of training health professionals on patient smoking cessation, Outcome 2 Patient asked to set a quit date.
1.3. Analysis
1.3. Analysis
Comparison 1 The effect of training health professionals on patient smoking cessation, Outcome 3 Patient asked to make a follow‐up appointment.
1.4. Analysis
1.4. Analysis
Comparison 1 The effect of training health professionals on patient smoking cessation, Outcome 4 Number of smokers counselled.
1.5. Analysis
1.5. Analysis
Comparison 1 The effect of training health professionals on patient smoking cessation, Outcome 5 Number of smokers receiving self‐help material.
1.6. Analysis
1.6. Analysis
Comparison 1 The effect of training health professionals on patient smoking cessation, Outcome 6 Number of smokers receiving nicotine gum/replacement therapy.
1.7. Analysis
1.7. Analysis
Comparison 1 The effect of training health professionals on patient smoking cessation, Outcome 7 Number of smokers prescribed a quit date.
2.1. Analysis
2.1. Analysis
Comparison 2 Sub‐group: treatment type, Outcome 1 Patient asked to set a quit date.
2.2. Analysis
2.2. Analysis
Comparison 2 Sub‐group: treatment type, Outcome 2 Patient asked to make a follow‐up appointment.
2.3. Analysis
2.3. Analysis
Comparison 2 Sub‐group: treatment type, Outcome 3 Number of smokers counselled.
2.4. Analysis
2.4. Analysis
Comparison 2 Sub‐group: treatment type, Outcome 4 Number of smokers receiving self‐help material.
2.5. Analysis
2.5. Analysis
Comparison 2 Sub‐group: treatment type, Outcome 5 Number of smokers receiving nicotine gum/replacement therapy.
3.1. Analysis
3.1. Analysis
Comparison 3 Sub‐group: treatment intensity ‐ Number of sessions, Outcome 1 Patient asked to set a quit date.
3.2. Analysis
3.2. Analysis
Comparison 3 Sub‐group: treatment intensity ‐ Number of sessions, Outcome 2 Patient asked to make a follow‐up appointment.
3.3. Analysis
3.3. Analysis
Comparison 3 Sub‐group: treatment intensity ‐ Number of sessions, Outcome 3 Number of smokers counselled.
3.4. Analysis
3.4. Analysis
Comparison 3 Sub‐group: treatment intensity ‐ Number of sessions, Outcome 4 Number of smokers receiving self‐help material.
3.5. Analysis
3.5. Analysis
Comparison 3 Sub‐group: treatment intensity ‐ Number of sessions, Outcome 5 Number of smokers receiving nicotine gum/replacement therapy.
4.1. Analysis
4.1. Analysis
Comparison 4 Sub‐group: treatment intensity ‐ Total exposure, Outcome 1 Patient asked to set a quit date.
4.2. Analysis
4.2. Analysis
Comparison 4 Sub‐group: treatment intensity ‐ Total exposure, Outcome 2 Patient asked to make a follow‐up appointment.
4.3. Analysis
4.3. Analysis
Comparison 4 Sub‐group: treatment intensity ‐ Total exposure, Outcome 3 Number of smokers counselled.
4.4. Analysis
4.4. Analysis
Comparison 4 Sub‐group: treatment intensity ‐ Total exposure, Outcome 4 Number of smokers receiving self‐help material.
4.5. Analysis
4.5. Analysis
Comparison 4 Sub‐group: treatment intensity ‐ Total exposure, Outcome 5 Number of smokers receiving nicotine gum/replacement therapy.
5.1. Analysis
5.1. Analysis
Comparison 5 Sub‐group: mode of intervention delivery, Outcome 1 Patient asked to set a quit date.
5.2. Analysis
5.2. Analysis
Comparison 5 Sub‐group: mode of intervention delivery, Outcome 2 Patient asked to make a follow‐up appointment.
5.3. Analysis
5.3. Analysis
Comparison 5 Sub‐group: mode of intervention delivery, Outcome 3 Number of smokers counselled.
5.4. Analysis
5.4. Analysis
Comparison 5 Sub‐group: mode of intervention delivery, Outcome 4 Number of smokers receiving self‐help material.
5.5. Analysis
5.5. Analysis
Comparison 5 Sub‐group: mode of intervention delivery, Outcome 5 Number of smokers receiving nicotine gum/replacement therapy.
6.1. Analysis
6.1. Analysis
Comparison 6 Sub‐group: behavioural change technique used, Outcome 1 Patient asked to set a quit date.
6.2. Analysis
6.2. Analysis
Comparison 6 Sub‐group: behavioural change technique used, Outcome 2 Patient asked to make a follow‐up appointment.
6.3. Analysis
6.3. Analysis
Comparison 6 Sub‐group: behavioural change technique used, Outcome 3 Number of smokers counselled.
6.4. Analysis
6.4. Analysis
Comparison 6 Sub‐group: behavioural change technique used, Outcome 4 Number of smokers receiving self‐help material.
6.5. Analysis
6.5. Analysis
Comparison 6 Sub‐group: behavioural change technique used, Outcome 5 Number of smokers receiving nicotine gum/replacement therapy.
7.1. Analysis
7.1. Analysis
Comparison 7 Sub‐group: type of professional being trained, Outcome 1 Patient asked to set a quit date.
7.2. Analysis
7.2. Analysis
Comparison 7 Sub‐group: type of professional being trained, Outcome 2 Patient asked to make a follow‐up appointment.
7.3. Analysis
7.3. Analysis
Comparison 7 Sub‐group: type of professional being trained, Outcome 3 Number of smokers counselled.
7.4. Analysis
7.4. Analysis
Comparison 7 Sub‐group: type of professional being trained, Outcome 4 Number of smokers receiving self‐help material.
7.5. Analysis
7.5. Analysis
Comparison 7 Sub‐group: type of professional being trained, Outcome 5 Number of smokers receiving nicotine gum/replacement therapy.
8.1. Analysis
8.1. Analysis
Comparison 8 Sub‐group: length of follow‐up, Outcome 1 Patient asked to set a quit date.
8.2. Analysis
8.2. Analysis
Comparison 8 Sub‐group: length of follow‐up, Outcome 2 Patient asked to make a follow‐up appointment.
8.3. Analysis
8.3. Analysis
Comparison 8 Sub‐group: length of follow‐up, Outcome 3 Number of smokers counselled.
8.4. Analysis
8.4. Analysis
Comparison 8 Sub‐group: length of follow‐up, Outcome 4 Number of smokers receiving self‐help material.
8.5. Analysis
8.5. Analysis
Comparison 8 Sub‐group: length of follow‐up, Outcome 5 Number of smokers receiving nicotine gum/replacement therapy.
9.1. Analysis
9.1. Analysis
Comparison 9 Sub‐group: risk of bias in the studies, Outcome 1 Patient asked to set a quit date.
9.2. Analysis
9.2. Analysis
Comparison 9 Sub‐group: risk of bias in the studies, Outcome 2 Patient asked to make a follow‐up appointment.
9.3. Analysis
9.3. Analysis
Comparison 9 Sub‐group: risk of bias in the studies, Outcome 3 Number of smokers counselled.
9.4. Analysis
9.4. Analysis
Comparison 9 Sub‐group: risk of bias in the studies, Outcome 4 Number of smokers receiving self‐help material.
9.5. Analysis
9.5. Analysis
Comparison 9 Sub‐group: risk of bias in the studies, Outcome 5 Number of smokers receiving nicotine gum/replacement therapy.

References

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Unrod 2007 {published data only}
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Wang 1994 {published data only}
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Wilson 1988 {published data only}
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Allen 1998 {published data only}
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Andrews 1999 {published data only}
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Andrews 2001 {published data only}
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Ballbe 2008 {published data only}
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Bernstein 2009 {published data only}
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Bobo 1997 {published data only}
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Campbell 1997 {published data only}
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Caplan 2011 {published data only}
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Carney 1995 {published data only}
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Etter 2006 {published data only}
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Goldberg 1994 {published data only}
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Gordon 2005a {published data only}
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Gordon 2005b {published data only}
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Kerr 2011 {published data only}
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Leong 2008 {published data only}
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Lindsay 1997 {published data only}
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Little 2009 {published data only}
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Manfredi 2011 {published data only}
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Martin 2010 {published data only}
    1. Martin BA, Bruskiewitz RH, Chewning BA. Effect of a tobacco cessation continuing professional education program on pharmacists' confidence, skills, and practice‐change behaviors. Journal of the American Pharmacists Association Jan 2010;50(1):9‐16.
Matten 2011 {published data only}
    1. Matten P, Morrison V, Rutledge DN, Chen T, Chung E, Wong SF. Evaluation of tobacco cessation classes aimed at hospital staff nurses. Oncology Nursing Forum 2011;38(1):67‐73.
McEwen 2002 {published data only}
    1. McEwen A, Preston A, West R. Effect of a GP desktop resource on smoking cessation activities of general practitioners. Addiction 2002;97(5):595‐7.
McEwen 2006 {published data only}
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McIntosh 2004 {published data only}
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McRobbie 2008 {published data only}
    1. McRobbie H, Hajek P, Feder G, Eldridge S. A cluster‐randomised controlled trial of a brief training session to facilitate general practitioner referral to smoking cessation treatment. Tobacco Control 2008;17:173‐6.
Meyer 2008 {published data only}
    1. Meyer C, Ulbricht S, Baumeister SE, Schumann A, Ruge J, Bischof G, Rumpf HJ, John U. Proactive interventions for smoking cessation in general medical practice: a quasi‐randomized controlled trial to examine the efficacy of computer‐tailored letters and physician‐delivered brief advice. Addiction 2008;103:294‐304. [DOI: 10.1111/j.1360-0443.2007.02031.x]
Moore 2005 {published data only}
    1. Moore E, Keerbs A. The impact of training medical assistants to provide smoking cessation counseling to an underserved patient population. Journal of Investigative Medicine 2005;53:S81.
Morgan 1996 {published data only}
    1. Morgan GD, Noll EL, Orleans CT, Rimer BK, Amfoh K, Bonney G. Reaching midlife and older smokers ‐ tailored interventions for routine medical care. Preventive Medicine 1996;25:346‐54.
Moss 2009 {published data only}
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Ockene 1991 {published data only}
    1. Ockene JK, Adams A, Pbert L, Luippold R, Hebert JR, Quirk M, Kalan K. The Physician‐Delivered Smoking Intervention Project: factors that determine how much the physician intervenes with smokers. J Gen Intern Med 1994;9:379‐84.
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Patwardhan 2010 {published data only}
    1. Patwardhan P, Chewing B. Randomized controlled trial evaluating the effect of a multimodal training intervention on brief tobacco cessation counseling in community chain pharmacies. Journal of the American Pharmacists Association 2010;50(2):260.
Pereira 2006 {published data only}
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Prokhorov 2010 {published data only}
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Source: PubMed

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