Nursing interventions for smoking cessation

BACKGROUND: Health care professionals frequently advise patients 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: The Cochrane Tobacco Addiction Group register was searched for studies of interventions using nurses or health visitors and an additional search made on CINAHL. SELECTION CRITERIA: Randomised trials with follow-up of at least 6 months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently. MAIN RESULTS: Fifteen studies comparing nursing intervention to a control or usual care found intervention to significantly increase the odds of quitting (Peto Odds Ratio 1.43, 95% CI 1.24-1.66). There was heterogeneity between the study results, but pooling using a random effects model did not alter the estimate of effect. There was no evidence from indirect comparison that interventions classified as intensive had a larger effect than less intensive ones. There was limited evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non hospitalised patients also showed evidence of efficacy. Three studies of nurse counseling on smoking cessation during a screening health check, not included in the main meta-analysis, suggested that under these conditions nursing intervention was likely to have less effect. REVIEWER'S CONCLUSIONS: The results indicate the potential benefits of smoking cessation advice and counseling given by nurses to their patients, with reasonable evidence that interventions can be effective. The challenge will be to incorporate smoking cessation intervention as part of standard practice so that all patients are given an opportunity to be queried about their tobacco use and to be given advice to quit along with reinforcement and follow-up.