Proactive Referral to Behavioral Smoking Cessation Programs by Healthcare Staff: A Systematic Review

Abstract

Introduction Behavioral smoking cessation programs are an effective tool for quitting smoking, yet remain underused by smokers. Proactive referral may be a promising strategy for healthcare staff to connect smokers to such programs. The aim of this study was to gain insight into the effectiveness and implementability of proactive referral of smokers to behavioral smoking cessation programs by healthcare staff. Methods A systematic review was conducted using five databases. Effectiveness of proactive referral was defined as the proportion of referred smokers who enrolled in a behavioral smoking cessation program. To determine the implementability of proactive referral, measures of feasibility, acceptability, adoption and referral rates were included as variables of interest. Out of 6,686 screened records, 34 articles were eligible for review. A narrative synthesis approach was used. Results The majority of the included studies investigated proactive referral within an e-referral system, combined with one or more intervention components which enhance implementation. Overall, proactive referral resulted in higher enrolment rates, especially among low-income smokers, and was found to be feasible, adoptable, and acceptable to healthcare staff. E-referral systems performed better in terms of implementability compared to fax referral systems. About half of the studies were of good quality. Many studies lacked information which resulted in lower quality scores. Conclusions The literature provides evidence that the proactive referral of smokers to behavioral smoking cessation programs by healthcare staff is effective and implementable across different settings. Based on the results, e-referral systems may be preferable to fax referral systems in terms of implementability. Implications This systematic review demonstrated that proactive referral has the potential to increase the reach of smoking cessation programs and reduce inequalities in the access to such programs. In the selection and implementation of behavioral smoking cessation programs with a proactive referral component, stakeholders (e.g., policymakers, healthcare funders, and healthcare professionals) may benefit from taking different aspects of proactive referral systems into account, such as the type of proactive referral system used and additional strategies which can enhance the implementability of the system.

A multi-component intervention increased access to smoking cessation treatment after hospitalization for atherosclerotic cardiovascular disease: a randomized trial

“…Our results underscore that high motivation, an offer of access to free cessation drugs, and provision of an information leaflet with clearly visible contact information are not sufficient measures to promote participation in smoking cessation programmes following hospitalization for an ASCVD event. These findings correspond with previous literature 41 , and suggest that permanent implementation of a pro-active recruitment strategy to post-discharge cessation programmes for this population would be beneficial. As the intervention builds on existing structures in the Norwegian healthcare system, it will be easy to implement in clinical practice.…”

“…Along these lines, a recent systematic review found that pro-active referral resulted in higher enrolment rate at behavioural cessation programmes in a variety of healthcare setting, especially among smokers with low socioeconomic status. 41 …”

Smoking cessation counselling patterns in cancer patients – survey of Lebanese physicians

“…Thus, having built-in automated referrals integrated with electronic health record (EHR)-based systems might serve as a helpful alternative to solve this problem in settings where EHRs are readily available [ 23 , 24 ]. An alternative method in settings where EHRs are not available includes fax referrals which were shown to be less effective than electronic referrals, but nevertheless necessary [ 25 ]. In fact, it is important to mention that regardless of the referral method, patients who received referrals to a smoking cessation program were found in the literature to be highly likely to actually stop smoking on follow up [ 25 , 26 ].…”

“…An alternative method in settings where EHRs are not available includes fax referrals which were shown to be less effective than electronic referrals, but nevertheless necessary [ 25 ]. In fact, it is important to mention that regardless of the referral method, patients who received referrals to a smoking cessation program were found in the literature to be highly likely to actually stop smoking on follow up [ 25 , 26 ].…”

Tabakentwöhnung bei hospitalisierten Patienten:innen – Stationär einleiten, ambulant fortführen

“…Bisherige randomisierte Studien konnten aber keinen Nachweis der Effektivität dieses Ansatzes erbringen, wenn dieser ohne weitere Unterstützung durchgeführt wurde [37,38]. Eine proaktive Anbindung an ein Entwöhnungsprogramm durch Pflegepersonal ist nach einer aktuellen Metaanalyse wirksam [39].…”