Interventions for smoking cessation in hospitalised patients: a systematic review

Abstract

Background-An admission to hospital provides an opportunity to help people stop smoking. Individuals may be more open to help at a time of perceived vulnerability, and may find it easier to quit in an environment where smoking is restricted or prohibited. Providing smoking cessation services during hospitalisation may help more people to attempt and sustain an attempt to quit. The purpose of this paper is to systematically review the eVectiveness of interventions for smoking cessation in hospitalised patients. Methods-We searched the Cochrane Tobacco Addiction Group register, CINAHL, and the Smoking and Health database for studies of interventions for smoking cessation in hospitalised patients. Randomised and quasi-randomised trials of behavioural, pharmacological, or multicomponent interventions to help patients stop smoking conducted with hospitalised patients who were current smokers or recent quitters were included. Studies of patients admitted for psychiatric disorders or substance abuse, those that did not report abstinence rates, and those with follow up of less than 6 months were excluded. Two of the authors extracted data independently for each paper, with assistance from others. Results-Intensive intervention (inpatient contact plus follow up for at least 1 month) was associated with a significantly higher cessation rate compared with controls (Peto odds ratio (OR) 1.82, 95% CI 1.49 to 2.22). Any contact during hospitalisation followed by minimal follow up failed to detect a statistically significant eVect on cessation rate, but did not rule out a 30% increase in smoking cessation (Peto OR 1.09, 95% CI 0.91 to 1.31). There was insuYcient evidence to judge the eVect of interventions delivered only during the hospital stay. Although the interventions increased quit rates irrespective of whether nicotine replacement therapy (NRT) was used, the results for NRT were compatible with other data indicating that it increases quit rates. There was no strong evidence that clinical diagnosis aVected the likelihood of quitting. Conclusions-High intensity behaviouralinterventions that include at least 1 month of follow up contact are eVective in promoting smoking cessation in hospitalised patients.

Tabagismo em pacientes internados em um hospital universitário

“…(7) Smokers who are hospitalized are usually more susceptible to anti-smoking messages because of their frailty, as well as of their fear of complications and death, resulting from the disease that led to their hospitalization, in addition to being forced to abstain from smoking because smoking is prohibited in the hospital environment. (14) In the present study, 44.4% of the respondents reported concomitant alcohol consumption, a common association known to make smoking cessation difficult.…”

“…(22) The withdrawal symptoms experienced immediately after discharge and the onset of depressive symptoms within 3 to 6 months after discharge are the major factors related to recurrence in these patients. (23) In reviews of smoking cessation interventions for hospitalized patients, conducted by Munafò et al, (14) and subsequently by Rigotti et al, (13) follow-up support for one month after discharge was found to reduce the recurrence rate significantly by month 6 of follow-up, indicating the strategic need to provide patients with follow-up support after discharge. In addition, preventing the recurrence of smoking in patients with cardiovascular disease reduces the risk of death and the risk of recurrence of cardiovascular events by 50%, (24) and, more importantly, it ensures that, at a future time when these patients might be in were smokers reported withdrawal symptoms.…”

Tabagismo em pacientes internados em um hospital geral

“…Although the stress of hospitalization and uncertainty concerning the treatment the patient will be submitted to hamper smoking cessation, the potential for forced abstinence in the hospital environment and worsening of disease facilitate cessation. (17) These factors make hospitalization a favorable moment for anti-smoking interventions, and health care institutions should take advantage of this opportunity. (18) The hospitalized smoker should initially receive information about the benefits of smoking cessation, with evaluation of the level of motivation to quit smoking and the degree of nicotine dependence, as well as receiving cognitivebehavioral therapy and pharmacological treatment, …”

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“…The benefits of smoking cessation interventions are well established [372][373][374][375] and the demonstrated failure of adherence to guideline recommendations for smoking cessation interventions no doubt contributed to the high proportion of smokers who failed to quit after ACS and who were thereby exposed to an increased risk of adverse outcomes.…”