Does support and intervention from nurses help people to stop smoking?

Background

Most smokers want to quit, and may be helped by advice and support from healthcare professionals. Nurses are the largest healthcare workforce, and are involved in virtually all levels of health care. The main aim of this review was to determine if nursing-delivered interventions can help adult smokers to stop smoking.

Study characteristics

This review of clinical trials covered 49 studies in which nurses delivered a stop smoking intervention to smokers. More than 17,000 participants were included in the main analysis, including hospitalized adults and adults in the general community. The most recent search was conducted in June 2013. All studies reported whether or not participants had quit smoking at six months or longer.

Results and quality of evidence

This review found moderate quality evidence that advice and support from nurses could increase people's success in quitting smoking, especially in a hospital setting. There was moderate evidence which found similar advice and encouragement given by nurses at health checks or prevention activities seems to be less effective, but may still have some impact. Results were not consistent across all studies and in some cases there were not very many studies contributing to comparisons.

Authors' conclusions: 

The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses, with reasonable evidence that intervention is effective. The evidence for an effect is weaker when interventions are brief and are provided by nurses whose main role is not health promotion or smoking cessation. The challenge will be to incorporate smoking behaviour monitoring and smoking cessation interventions as part of standard practice so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and/or counselling to quit along with reinforcement and follow-up.

Read the full abstract...
Background: 

Healthcare professionals, including nurses, frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions.

Objectives: 

To determine the effectiveness of nursing-delivered smoking cessation interventions.

Search strategy: 

We searched the Cochrane Tobacco Addiction Group specialized Register and CINAHL in June 2013.

Selection criteria: 

Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow-up of at least six months.

Data collection and analysis: 

Two authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed-effect model and reported the outcome as a risk ratio (RR) with a 95% confidence interval (CI).

Main results: 

Forty-nine studies met the inclusion criteria. Pooling 35 studies (over 17,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention to increase the likelihood of quitting (RR 1.29; 95% CI 1.20 to 1.39). In a subgroup analysis the estimated effect size was similar for the group of seven studies using a particularly low intensity intervention but the confidence interval was wider. There was limited indirect evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non-hospitalized adults also showed evidence of benefit. Eleven studies comparing different nurse-delivered interventions failed to detect significant benefit from using additional components. Six studies of nurse counselling on smoking cessation during a screening health check or as part of multifactorial secondary prevention in general practice (not included in the main meta-analysis) found nursing intervention to have less effect under these conditions.