Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis

Abstract

Introduction Lung cancer screening presents an important teachable moment to promote smoking cessation, but the most effective strategy to deliver support in this context remains to be established. Methods We undertook a systematic review and meta-analysis of smoking cessation interventions delivered during lung health screening, published prior to 20/07/2022 MEDLINE, PsychINFO, CENTRAL, EMBASE, CINAHL and Scopus databases. Two reviewers screened titles, and abstracts, four reviewed each full text using prespecified criteria, extracted relevant data, assessed risk of bias and confidence in findings using the GRADE criteria. The review was registered prospectively on PROSPERO (CRD42021242431). Results 10 randomised controlled trials (RCT) and 3 observational studies with a control group were identified. Meta-analysis of 9 RCTs demonstrated that smoking cessation interventions delivered during lung screening programmes increased quit rates compared to usual care (OR: 2.01, 95%: 1.49-2.72 p<0.001). 6 RCTs using intensive (>3 behavioural counselling sessions) interventions demonstrated greater quit rates compared to usual care (OR: 2.11, 95% CI 1.53-2.90, p<0.001). A meta-analysis of 2 RCTs found intensive interventions were more effective than non-intensive (OR: 2.07, 95%CI 1.26-3.40 p=0.004), Meta-analysis of 2 RCTs of non-intensive interventions (<2 behavioural counselling sessions or limited to online information audio take-home materials such as pamphlets) did not show a higher quit rate than usual care (OR: 0.90, 95% CI 0.39-2.08 p=0.80). Discussion Moderate quality evidence supports smoking cessation interventions delivered within a lung screening setting compared to usual care, with high-quality evidence that more intensive interventions are likely to be most effective