Can training health professionals in stop-smoking support help more of their patients quit smoking?

Key messages

Training health professionals in quit-smoking techniques (also known as 'smoking cessation') can help their patients quit smoking.
Training with multiple components (e.g. counselling of patients plus offers of follow-up appointments, or provision of self-help materials), as well as feedback and ongoing resources for health professionals may be even more helpful.
More research that combines training of health professionals with stop-smoking medicines (such as nicotine replacement therapy) or other stop-smoking aids should be considered to see if any of this helps more people quit.

What is training for health professionals?

Training health professionals in stop-smoking techniques helps encourage health professionals to ask patients if they are smoking. If a patient is smoking, health professionals are then equipped with the latest evidence to support patients through their attempts to quit smoking.

What did we want to find out?

We wanted to find out if training health professionals in stop-smoking techniques helps their patients to quit, and if more intensive training helps more of their patients to quit.

What did we do?

We searched for studies that trained health professionals in stop-smoking techniques. The health professionals then used these techniques to help support their patients to quit smoking. These studies all compared the trained health professionals to control groups, where health professionals did not receive training, received lower-intensity training, or training on something other than smoking. We compared and summarised the results of the studies, and rated our confidence in the evidence based on factors such as study methods and sizes.

What did we find?

We included 29 studies in this review. Altogether, the studies trained 4,030 health professionals who provided stop-smoking support to 38,178 patients who smoked.

We found that when healthcare professionals were provided with smoking cessation training, more of their patients were likely to quit, compared with patients whose healthcare professionals were not trained.

We found that when healthcare professionals completed higher-intensity training, more patients may have successfully quit than for health professionals who received lower-intensity training.

We also found that more people may quit smoking when the healthcare professionals who treat them receive training in smoking cessation:

and provide nicotine replacement therapy to their patients; or
and prompts or reminders.

However, we are uncertain about both of these results, and in each case, they might not help more people to quit.

What are the limitations of this evidence?

We are confident about the finding that when healthcare professionals were provided with stop-smoking training, more of their patients were likely to quit. We have less confidence in the other findings because the methods used by some studies were unclear, and some studies did not conduct biological tests to confirm reports of non-smoking amongst patients.

How current is this evidence?

The evidence is current to August 2024.

Read the full 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 assess the effectiveness of training healthcare professionals to deliver smoking cessation interventions to their patients, and to assess the effects of training characteristics (such as content, setting, delivery, and intensity).

Search strategy

We searched the following databases from inception to August 2024: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; PsycINFO; ClinicalTrials.gov (through CENTRAL); and the World Health Organization International Clinical Trials Registry Platform (through CENTRAL). We also searched the references of eligible studies.

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

High-certainty evidence supports the effectiveness of training health professionals in smoking cessation when compared with no training. Multi-component investigations incorporating new pharmacological interventions for smoking cessation (such as varenicline and bupropion) or other cessation aids alongside physician training should be considered to determine if any additional benefit in long-term abstinence can be obtained.

Funding

Production of this review was supported by PhD scholarship funding from the University of Adelaide and co-funded by Houd Research Group, awarded to KS.

Registration

This review was first published outside of Cochrane in 1994 and subsequently updated as a Cochrane review in 2000 (DOI: 10.1002/14651858.CD000214) and 2012 (DOI: 10.1002/14651858.CD000214.pub2). No protocol was published or registered.

Citation

Sharrad KJ, Carson-Chahhoud KV, Verbiest MEA, Greenslade S, Parkhouse T, Assendelft WJJ, Crone MR, Livingstone-Banks J. Training health professionals in smoking cessation. Cochrane Database of Systematic Reviews 2026, Issue 2. Art. No.: CD000214. DOI: 10.1002/14651858.CD000214.pub3.