Clinical trial comparing nicotine replacement therapy (NRT) plus brief counselling, brief counselling alone, and minimal intervention on smoking cessation in hospital inpatients

Abstract

Background: Guidelines recommend that smoking cessation interventions are offered in all clinical settings to all smokers willing to make a quit attempt. Since the effectiveness of routine provision of behavioural counselling and nicotine replacement therapy (NRT) to smokers admitted to hospital has not been established, a randomised controlled trial of these interventions given together compared with counselling alone or minimal intervention was performed in hospital inpatients. Methods: Medical and surgical inpatients who were current smokers at the time of admission were randomised to receive either usual care (no additional advice at admission), counselling alone (20 minute intervention with written materials), or NRT plus counselling (counselling intervention with a 6 week course of NRT). Continuous and point prevalence abstinence from smoking (validated by exhaled carbon monoxide <10 ppm) was measured at discharge from hospital and at 3 and 12 months, and self-reported reduction in cigarette consumption in smokers was assessed at 3 and 12 months. Results: 274 inpatient smokers were enrolled. Abstinence was higher in the NRT plus counselling group (n=91) than in the counselling alone (n=91) or usual care (n=92) groups. The difference between the groups was significant for validated point prevalence abstinence at discharge (55%, 43%, 37% respectively, p=0.045) and at 12 months (17%, 6%, 8%, p=0.03). The respective differences in continuous validated abstinence at 12 months were 11%, 4%, 8% (p=0.25). There was no significant difference between counselling alone and usual care, or in reduction in cigarette consumption between the treatment groups. Conclusions: NRT given with brief counselling to hospital inpatients is an effective routine smoking cessation intervention.

Tabagismo em pacientes internados em um hospital universitário

“…Studies have shown that, despite the ban on in-hospital smoking, 25% of patients smoke in the hospital environment, and that, of hospitalized smokers, 55% report withdrawal symptoms, only 6% receive nicotine replacement therapy, 63% relapse in the first week, and 45% relapse on post-discharge day 1. (5)(6)(7)(8) There are few national data on in-hospital smoking and its management. In a study conducted in a general hospital in the city of São Paulo, Brazil, in which the prevalence of active smoking among inpatients was 17%, the authors drew attention to the need to obtain information about smokers admitted to other hospitals in the country, in order to develop protocols for the treatment of such patients.…”

The effectiveness of smoking cessation interventions prior to surgery: A systematic review

“…Table 1 summarises the studies included in this review. Of the nine studies, three were conducted the UK, (Andrews et al, 2006;McHugh et al, 2001;Molyneux et al, 2003) three in Australia, (Myles et al, 1996;Myles et al, 2004;Wolfenden et al, 2005) two in Denmark (Moller, et al, 2002;Sorensen, & Jorgensen, Key: CABG = Coronary Artery Bypass Graft surgery; Exp = Experimental Group; Con = Control Group; n.s. = non significant; sig.…”

“…Based on the inclusion criteria, 51 full text articles were obtained but following further scrutiny by the reviewers 42 of these were excluded. Nine full text articles were retained in this review (Andrews, Bale, Chu, Crame, & Aveyard, 2006;McHugh et al, 2001;Moller, et al, 2002;Myles et al, 1996;Myles, Leslie, Angliss, Mezzavia, & Lee, 2004;Molyneux et al, 2003;Ratner et al, 2004;Sorensen, & Jorgensen, 2003;Wolfenden et al, 2005). Studies were excluded if the smoking cessation intervention was delivered postsurgery, or they were not genuine RCTs.…”

“…= non significant; sig. = statistically significant * = post-operatively abstinence or reduction by more than half or normal daily rate A number of different intervention methods were used in the papers: six studies used some form of counselling (McHugh et al, 2001;Moller, et al, 2002;Molyneux et al, 2003;Ratner et al, 2004;Sorensen, & Jorgensen, 2003;Wolfenden et al, 2005), five studies used counselling together with Nicotine Replacement Therapy (NRT) (Moller, et al, 2002;Molyneux et al, 2003;Ratner et al, 2004;Sorensen, & Jorgensen, 2003;Wolfenden et al, 2005), one study used only NRT (bupropion) (Myles et al, 2004), one study used a letter offering smoking cessation advice (Andrews et al, 2006), one study delivered smoking cessation advice via an audio cassette (Myles et al, 1996) and one study used counselling, NRT and offered self-help material tailored to individual needs (Wolfenden et al, 2005). Thus most interventions used a multifaceted behavioural approach.…”

“…Three studies used self-report as the sole method of eliciting smoking status (Andrews et al, 2006;McHugh et al, 2001;Wolfenden et al, 2005) four used self-report together with CO readings (Myles et al, 1996;Myles et al, 2004;Ratner et al, 2004;Sorensen, & Jorgensen, 2003), with two of these also using cotinine to verify smoking status, (Ratner et al, 2004;Sorensen, & Jorgensen, 2003), and two studies used CO readings only (Moller, et al, 2002;Molyneux et al, 2003). The preoperative period varied between studies and in one study this was not reported (Myles et al, 2004), but in the remainder time ranged from during surgery (Myles et al, 1996) to 8.5 months.…”