Nursing interventions for smoking cessation

BACKGROUND: Health care professionals, including nurses, 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: We searched the Cochrane Tobacco Addiction Group specialized register and CINAHL in June 2003. 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. MAIN RESULTS: Twenty-nine studies met the inclusion criteria. Twenty studies comparing a nursing intervention to a control or to usual care found the intervention to significantly increase the odds of quitting (Peto Odds Ratio 1.47, 95% CI 1.29 to 1.68). There was heterogeneity among the study results, but pooling using a random effects model did not alter the estimate of a statistically significant effect. There was limited evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non-hospitalized patients also showed evidence of benefit. Five studies comparing different nurse-delivered interventions failed to detect significant benefit from using additional components. Five 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 the nursing intervention to have less effect under these conditions. REVIEWER'S CONCLUSIONS: The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses to patients, with reasonable evidence that interventions can be effective. 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.