A randomised controlled trial to evaluate the efficacy of a nurse‐provided intervention for hospitalised smokers

Abstract

Objective: Does the provision of a nurse‐based intervention lead to smoking cessation in hospital patients? Methods: At tertiary teaching hospital in Newcastle, Australia, 4,779 eligible (aged 18–80, admitted for at least 24 hours, and able to provide informed consent) and consenting (73.4%) in‐patients were recruited into a larger cross‐sectional survey. 1,422 (29.7%) smokers (in the last 12 months) were randomly assigned to control (n=711) or intervention group (n=711). The brief nurse‐delivered intervention incorporated: tailored information, assessment of withdrawal, offer of nicotine replacement therapy, booklets, and a discharge letter. Self‐reported cessation at 12 months was validated with CO and salivary cotinine. Results: There were no significant differences between groups in self‐reported abstinence at three or 12 months post intervention, based on an intention to treat analysis. At three months, self‐reported abstinence was 27.3% (I) and 27.5% (C); at 12 months was 18.5% (I) and 20.6% (C). There were no differences in validation of self‐report between intervention and control groups at 12 months. Conclusion: This brief nurse‐provided in‐patient intervention did not significantly increase the smoking cessation rates compared with the control group at either three or 12‐month follow‐up. Implications: A systematic total quality improvement model of accountable outcome‐focused treatment, incorporating assertive physician‐led pharmacotherapy, routine assessment and recording of nicotine dependence (ICD 10 coding), in‐and outpatient services and engagement from multidisciplinary teams of health professionals may be required to improve treatment modalities for this chronic addictive disorder.

Nursing intervention and smoking cessation: Meta-analysis update

“…In most of the research, the basis for sample size was not specified a priori, nor was a retrospective power analysis conducted. Two recent studies 31,39 used power analyses to determine sample size. Most trials did not report "refusal to participate" rates.…”

“…[21][22][23]43 The most recent trials reported some form of biochemical verification of self-reports. 26,28,31,32,33,39 All of the trials used convenience rather than randomly selected samples. Only one of the studies 50 did not let participants know initially that they were going to be part of a smoking-cessation study.…”

“…However, because of the NRT use rates, it is probable that it contributed to the overall effect of the nursing intervention. NRT use was part of the intervention in the Canga et al study, 38 with 17% of the intervention group accepting a prescription, in the Chouinard and Robichaud-Ekstrand 39 study, in which 39% used it in the most intensive intervention group and 10% in the "no intervention" group, and in the Nagle 31 study, in which 4.1% of the intervention participants used it.…”

“…40 Sixteen of the studies focused on adults with diagnosed cardiovascular health problems. [21][22][23][24][25][26][27][30][31][32][34][35][36]39,41,48 In addition, there were single studies of patients with elective surgery, 33 diabetes, 38 and respiratory disease. 49 Three trials examined smoking-cessation intervention as a component of multiple risk factor reduction interventions in adults with cardiovascular disease.…”

“…One trial 20 had two parts with randomization at each stage, so it is treated here as two separate studies, making a total of 35 studies. Fifteen trials [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] intervened with hospitalized patients; one 36 recruited hospitalized patients, but the intervention was given after discharge. Fifteen studies 20,37-50 recruited patients from primary care or outpatient clinics.…”