Individual behavioural counselling for smoking cessation

Tim Lancaster; Lindsay F Stead

doi:10.1002/14651858.CD001292.pub3

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Figure 1

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Figure 2

Forest plot of comparison: 1 Individual counselling compared to minimal contact control, outcome: 1.1 Smoking cessation at longest follow‐up.

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Analysis 1.1

Comparison 1 Individual counselling compared to minimal contact control, Outcome 1 Smoking cessation at longest follow‐up.

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Analysis 2.1

Comparison 2 More intensive versus less intensive counselling, Outcome 1 Smoking cessation at longest follow‐up.

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Analysis 3.1

Comparison 3 Comparisons between counselling approaches of similar intensity, Outcome 1 Smoking cessation at longest follow‐up.

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Summary of findings for the main comparison. Individual counselling compared to minimal contact control for smoking cessation

Patient or population: People who smoke Setting: Healthcare and community settings Intervention: Individual counselling from a smoking cessation counsellor including at least one face‐to‐face session lasting 10 minutes or more Comparison: Minimal‐contact control (usual care, brief advice or self‐help materials)
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Numbers quit in control condition	Numbers quit after individual counselling
Smoking cessation at longest follow‐up ‐ 6 months or more No systematic pharmacotherapy	Study population		RR 1.57 (1.40 to 1.77)	11,100 (27 RCTs)	⊕⊕⊕⊕ HIGH	Limiting to studies at low risk of bias on all assessed domains marginally increases estimate of effect
	7 per 100	11 per 100 (10 to 12)
Smoking cessation at longest follow‐up ‐ 6 months or more Pharmacotherapy offered to all participants	Study population		RR 1.24 (1.01 to 1.51)	2662 (6 RCTs)	⊕⊕⊕⊝ MODERATE ¹	Higher control group quit rate reflecting use of pharmacotherapy
	11 per 100	13 per 100 (11 to 16)
*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
¹Downgraded due to wide confidence intervals.

Summary of findings for the main comparison. Individual counselling compared to minimal contact control for smoking cessation

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Summary of findings 2. More intensive compared to less intensive counselling for smoking cessation

More intensive compared to less intensive counselling for smoking cessation
Patient or population: People who smoke Setting: Healthcare and community settings Intervention: More intensive individual counselling (± pharmacotherapy) Comparison: Individual counselling (± pharmacotherapy)
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Numbers quit with less intensive counselling	Numbers quit with more intensive counselling
Smoking cessation at longest follow‐up	Without pharmacotherapy		RR 1.29 (1.09 to 1.53)	2920 (11 RCTs)	⊕⊕⊕⊕ HIGH	Effect estimates for subgroups of studies with and without pharmacotherapy for all participants overlapped, so the overall pooled estimate is used with alternative control group estimates from subgroups
	9 per 100 ¹	12 per 100 (10 to 14)
	With pharmacotherapy
	14 per 100 ²	18 per 100 (15 to 21)
*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; OR: Odds 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
¹Based on average in studies without pharmacotherapy. ²Based on average in studies with pharmacotherapy.

Summary of findings 2. More intensive compared to less intensive counselling for smoking cessation

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Comparison 1. Individual counselling compared to minimal contact control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation at longest follow‐up Show forest plot	33	13762	Risk Ratio (M‐H, Fixed, 95% CI)	1.48 [1.34, 1.64]

1.1 Counselling versus control (no systematic pharmacotherapy)	27	11100	Risk Ratio (M‐H, Fixed, 95% CI)	1.57 [1.40, 1.77]
1.2 Counselling plus pharmacotherapy versus pharmacotherapy alone	6	2662	Risk Ratio (M‐H, Fixed, 95% CI)	1.24 [1.01, 1.51]

Comparison 1. Individual counselling compared to minimal contact control

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Comparison 2. More intensive versus less intensive counselling

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation at longest follow‐up Show forest plot	11	2920	Risk Ratio (M‐H, Fixed, 95% CI)	1.29 [1.09, 1.53]

1.1 No pharmacotherapy	4	872	Risk Ratio (M‐H, Fixed, 95% CI)	1.42 [0.98, 2.06]
1.2 Adjunct to pharmacotherapy	8	2048	Risk Ratio (M‐H, Fixed, 95% CI)	1.26 [1.04, 1.52]

Comparison 2. More intensive versus less intensive counselling

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Comparison 3. Comparisons between counselling approaches of similar intensity

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation at longest follow‐up Show forest plot	5		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Relapse prevention versus health belief model	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Motivational interviewing versus health education	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 Counselling versus equal sessions of psychoeducation	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.4 Front‐loaded versus weekly counselling	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.5 Face‐to‐face versus telephone counselling	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 3. Comparisons between counselling approaches of similar intensity

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