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Cochrane Database of Systematic Reviews

Terapia conductual de grupo para el abandono del hábito de fumar

Información

DOI:
https://doi.org/10.1002/14651858.CD001007.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 31 marzo 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Tabaquismo

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Lindsay F Stead

    Correspondencia a: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

    [email protected]

  • Allison J Carroll

    Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA

  • Tim Lancaster

    Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

Contributions of authors

LS & TL jointly conceived the review. LS & AC shared data extraction and all authors were involved in drafting the review.

Sources of support

Internal sources

  • Department of Primary Health Care, Oxford University, UK.

  • National Institute for Health Research (NIHR) School for Primary Care Research, UK.

External sources

  • NHS Research and Development National Cancer Programme, England, UK.

  • Predoctoral Individual National Research Service Award (F31 HL129494), USA.

    Support for AC's effort and training

Declarations of interest

LS; None known. AC; None known. TL; None known.

Acknowledgements

Dr B Bonevski for assistance with data extraction. Prof V Rice for additional data. Peer referees for valuable suggestions.

Version history

Published

Title

Stage

Authors

Version

2017 Mar 31

Group behaviour therapy programmes for smoking cessation

Review

Lindsay F Stead, Allison J Carroll, Tim Lancaster

https://doi.org/10.1002/14651858.CD001007.pub3

2005 Apr 20

Group behaviour therapy programmes for smoking cessation

Review

Lindsay F Stead, Tim Lancaster

https://doi.org/10.1002/14651858.CD001007.pub2

2002 Apr 22

Group behaviour therapy programmes for smoking cessation

Review

Lindsay F Stead, Tim R Lancaster

https://doi.org/10.1002/14651858.CD001007

Differences between protocol and review

For the 2017 update, we include a 'Summary of findings' table for the main comparisons.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Forest plot of comparison 1.1: Group programme vs self‐help programme.
Figuras y tablas -
Figure 2

Forest plot of comparison 1.1: Group programme vs self‐help programme.

Comparison 1 Group‐format behavioural programmes vs other format, Outcome 1 Smoking cessation. Group programme vs self‐help programme.
Figuras y tablas -
Analysis 1.1

Comparison 1 Group‐format behavioural programmes vs other format, Outcome 1 Smoking cessation. Group programme vs self‐help programme.

Comparison 1 Group‐format behavioural programmes vs other format, Outcome 2 Smoking cessation. Group programme vs brief support.
Figuras y tablas -
Analysis 1.2

Comparison 1 Group‐format behavioural programmes vs other format, Outcome 2 Smoking cessation. Group programme vs brief support.

Comparison 1 Group‐format behavioural programmes vs other format, Outcome 3 Smoking cessation. Group plus pharmacotherapy vs pharmacotherapy alone.
Figuras y tablas -
Analysis 1.3

Comparison 1 Group‐format behavioural programmes vs other format, Outcome 3 Smoking cessation. Group plus pharmacotherapy vs pharmacotherapy alone.

Comparison 1 Group‐format behavioural programmes vs other format, Outcome 4 Smoking cessation. Group programme vs individual therapy.
Figuras y tablas -
Analysis 1.4

Comparison 1 Group‐format behavioural programmes vs other format, Outcome 4 Smoking cessation. Group programme vs individual therapy.

Comparison 1 Group‐format behavioural programmes vs other format, Outcome 5 Smoking cessation. Group vs 'no intervention' controls.
Figuras y tablas -
Analysis 1.5

Comparison 1 Group‐format behavioural programmes vs other format, Outcome 5 Smoking cessation. Group vs 'no intervention' controls.

Comparison 2 Comparisons between different group programmes [Outcome Long term cessation for all comparisons], Outcome 1 "Skills training".
Figuras y tablas -
Analysis 2.1

Comparison 2 Comparisons between different group programmes [Outcome Long term cessation for all comparisons], Outcome 1 "Skills training".

Comparison 2 Comparisons between different group programmes [Outcome Long term cessation for all comparisons], Outcome 2 Mood management.
Figuras y tablas -
Analysis 2.2

Comparison 2 Comparisons between different group programmes [Outcome Long term cessation for all comparisons], Outcome 2 Mood management.

Comparison 2 Comparisons between different group programmes [Outcome Long term cessation for all comparisons], Outcome 3 Manipulation of group dynamics.
Figuras y tablas -
Analysis 2.3

Comparison 2 Comparisons between different group programmes [Outcome Long term cessation for all comparisons], Outcome 3 Manipulation of group dynamics.

Comparison 2 Comparisons between different group programmes [Outcome Long term cessation for all comparisons], Outcome 4 Other miscellaneous comparisons.
Figuras y tablas -
Analysis 2.4

Comparison 2 Comparisons between different group programmes [Outcome Long term cessation for all comparisons], Outcome 4 Other miscellaneous comparisons.

Summary of findings for the main comparison. Group‐format behavioural programmes compared to alternative support for smoking cessation

Patient or population: People who smoke
Setting: Smoking cessation clinics predominantly recruiting people interested in quitting smoking, from community and healthcare settings
Intervention: Group‐format behavioural programmes
Comparison: Various

Outcome: Smoking cessation assessed at least 6 months after start of treatment, based on self‐report, ± biochemical validation of abstinence

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Numbers quit in control conditions

Numbers quit after group programme

Group programme compared to self‐help programme

Moderate

RR 1.88
(1.52 to 2.33)

4395
(13 RCTs) 2

⊕⊕⊕⊝
MODERATE 3

5 per 100 1

9 per 100
(8 to 12)

Group programme compared to brief support

Moderate

RR 1.25
(1.07 to 1.46)

7601
(16 RCTs)

⊕⊕⊝⊝
LOW 3 4

5 per 100 5

6 per 100
(5 to 7)

Group programme compared to face‐to‐face individual intervention

Moderate

RR 0.99
(0.76 to 1.28)

980
(6 RCTs)

⊕⊕⊕⊝
MODERATE 3

11 per 100 6

11 per 100
(8 to 14)

Group programme plus pharmacotherapy versus pharmacotherapy and brief support alone

Moderate

RR 1.11
(0.93 to 1.33)

1523
(5 RCTs)

⊕⊕⊕⊝
MODERATE 8

18 per 100 7

20 per 100
(17 to 24)

Group programme versus 'no intervention' controls

Moderate

RR 2.60
(1.80 to 3.76)

1098
(9 RCTs)

⊕⊕⊝⊝
LOW 3 9

5 per 100

13 per 100
(9 to 19)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1Moderate assumed control condition quit rate, mid way between higher crude average and lower weighted average.
2Including 4 cluster‐randomized studies.
3Most studies at unclear risk of bias for allocation and concealment, probably reflecting poor reporting in old studies. Downgraded, but potential for large over‐ or under‐estimation of effect size low.
4Heterogeneity in pooled estimate.
5Based on crude average in control conditions. The weighted average would be 4%; one large trial had very low quit rates from brief support.
6Based on average in studies of individual counselling without pharmacotherapy from review of individual counselling.
7Based on control condition rate from review of behavioural adjuncts to pharmacotherapy.
8Downgraded due to imprecision. A larger review of the effect of increasing behavioural support as an adjunct to pharmacotherapy detected a small benefit.
9Most studies did not biochemically validate abstinence.

Figuras y tablas -
Summary of findings for the main comparison. Group‐format behavioural programmes compared to alternative support for smoking cessation
Comparison 1. Group‐format behavioural programmes vs other format

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Smoking cessation. Group programme vs self‐help programme Show forest plot

13

4395

Risk Ratio (M‐H, Fixed, 95% CI)

1.88 [1.52, 2.33]

1.1 Group vs self‐help (same programme content)

8

2411

Risk Ratio (M‐H, Fixed, 95% CI)

2.37 [1.76, 3.20]

1.2 Group vs self‐help (different programmes)

5

1984

Risk Ratio (M‐H, Fixed, 95% CI)

1.42 [1.04, 1.94]

2 Smoking cessation. Group programme vs brief support Show forest plot

16

7601

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [1.07, 1.46]

2.1 Physician, nurse, or pharmacist advice

14

7286

Risk Ratio (M‐H, Fixed, 95% CI)

1.22 [1.03, 1.43]

2.2 Health Education

2

315

Risk Ratio (M‐H, Fixed, 95% CI)

1.81 [0.94, 3.46]

3 Smoking cessation. Group plus pharmacotherapy vs pharmacotherapy alone Show forest plot

5

1523

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.93, 1.33]

4 Smoking cessation. Group programme vs individual therapy Show forest plot

6

980

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.76, 1.28]

4.1 Group vs individual (similar intensity & content)

4

539

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.68, 1.81]

4.2 Group vs individual (different intensity/content)

2

441

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.69, 1.28]

5 Smoking cessation. Group vs 'no intervention' controls Show forest plot

9

1098

Risk Ratio (M‐H, Fixed, 95% CI)

2.60 [1.80, 3.76]

Figuras y tablas -
Comparison 1. Group‐format behavioural programmes vs other format
Comparison 2. Comparisons between different group programmes [Outcome Long term cessation for all comparisons]

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 "Skills training" Show forest plot

9

1599

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.98, 1.37]

1.1 Substitution of components (controlling for programme length)

5

556

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.92, 1.67]

1.2 Addition of components (not controlled for programme length)

4

1043

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.92, 1.37]

2 Mood management Show forest plot

7

1367

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.84, 1.32]

2.1 Same contact time

5

1019

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.79, 1.41]

2.2 Longer contact time

2

348

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.73, 1.52]

2.3 Mood Management versus motivational interviewing

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Manipulation of group dynamics Show forest plot

4

702

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.87, 1.46]

4 Other miscellaneous comparisons Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 CBT vs group health education

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 Programme for people with schizophrenia vs standard programme

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Total abstinence vs controlled smoking programme emphasis

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.4 Culturally‐targetted vs standard treatment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.5 Programme for at‐risk subgroups vs standard

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.6 CBT vs relaxation training

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.7 Additional psychodrama compared to group programme

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 2. Comparisons between different group programmes [Outcome Long term cessation for all comparisons]