Telephone counselling for smoking cessation

Lindsay F Stead; Jamie Hartmann‐Boyce; Rafael Perera; Tim Lancaster

doi:10.1002/14651858.CD002850.pub3

Cochrane Database of Systematic Reviews

Asesoramiento telefónico para el abandono del hábito de fumar

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DOI:

https://doi.org/10.1002/14651858.CD002850.pub3 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

12 agosto 2013see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Tabaquismo

Copyright:

Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

Lindsay F Stead

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

[email protected]
Jamie Hartmann‐Boyce

Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Rafael Perera

Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Tim Lancaster

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

Contributions of authors

LS and TL contributed to developing the protocol, extracting data and writing the review. RP became an author from issue 1 2003 and extracted data, assisted with the meta‐regression. and contributed to updating the text. JH‐B became an author from 2013 and contributed to extracting data and updating the text.

Sources of support

Internal sources

National Institute for Health Research (NIHR) School for Primary Care Research, UK.
Department of Primary Care Health Sciences, University of Oxford, UK.

External sources

NHS Research & Development Programme, UK.

Declarations of interest

None known

Acknowledgements

Elaine Harkness assisted with data extraction in the first version of this review. Hitomi Kobayashi translated a paper from Japanese. We would like to acknowledge the helpful suggestions of Ed Lichtenstein and Corinne Husten on both the original version of the review and the update in 2006. Additional data were provided by Vance Rabius and Jennifer McClure, and other authors confirmed or clarified data. Data from Flöter 2009 were extracted by Carole Clair.

Version history

Published

Title

Stage

Authors

Version

2019 May 02

Telephone counselling for smoking cessation

Review

William Matkin, José M. Ordóñez‐Mena, Jamie Hartmann‐Boyce

https://doi.org/10.1002/14651858.CD002850.pub4

2013 Aug 12

Telephone counselling for smoking cessation

Review

Lindsay F Stead, Jamie Hartmann‐Boyce, Rafael Perera, Tim Lancaster

https://doi.org/10.1002/14651858.CD002850.pub3

2006 Jul 19

Telephone counselling for smoking cessation

Review

Lindsay F Stead, Rafael Perera, Tim Lancaster

https://doi.org/10.1002/14651858.CD002850.pub2

2003 Jan 20

Telephone counselling for smoking cessation

Review

Lindsay F Stead, Tim Lancaster, Rafael Perera

https://doi.org/10.1002/14651858.CD002850

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adult; Female; Humans; Male; Middle Aged; Pregnancy;

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.

Figure 1

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

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Figure 2

Comparison 3. Interventions for callers to quitlines. Cessation at longest follow‐up

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Figure 3

Comparison 4. Interventions for smokers not calling quitlines ‐ subgroups by baseline support. Cessation at longest follow‐up

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Analysis 1.1

Comparison 1 Interventions for callers to quitlines ‐ effect of additional proactive calls, Outcome 1 Cessation at longest follow‐up.

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Analysis 2.1

Comparison 2 Interventions for callers to quitlines ‐ comparison of different support during a single call, Outcome 1 Cessation at longest follow‐up.

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Analysis 3.1

Comparison 3 Offer of counselling via quitlines/helplines/hotlines, Outcome 1 Long term cessation.

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Analysis 4.1

Comparison 4 Interventions for smokers not calling quitlines ‐ subgroups by baseline support, Outcome 1 Cessation at longest follow‐up ‐ All trials, subgroups by amount of control group support.

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Analysis 5.1

Comparison 5 Interventions for smokers not calling quitlines ‐ subgroups by intensity: 1‐2, 3‐6, >6 calls, Outcome 1 Cessation at longest follow‐up.

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Analysis 6.1

Comparison 6 Interventions for smokers not calling quitlines ‐ subgroups by motivation, Outcome 1 Long‐term cessation.

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Summary of findings for the main comparison. Interventions for callers to quitlines ‐ effect of additional proactive calls for smoking cessation

Interventions for callers to quitlines ‐ effect of additional proactive calls for smoking cessation
Patient or population: callers to quitlines Intervention: additional proactive calls
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Additional proactive calls
Smoking cessation self reported abstinence (majority) Follow‐up: 6+ months	Study population		RR 1.38 (1.28 to 1.49)	30182 (12 studies)	⊕⊕⊕⊝ moderate^2,3
	76 per 1000¹	105 per 1000 (97 to 113)
	Low
	50 per 1000¹	69 per 1000 (64 to 75)
	High
	150 per 1000¹	207 per 1000 (192 to 224)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (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: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Low control rate reflects lower end of range evident in trials; 4/12 had control rates < 5%. High control rate likely to be applicable for people also using pharmacotherapy ² Estimated effect not sensitive to inclusion of studies judged at risk of bias ³ Heterogeneity evident; two UK studies had point estimates suggesting no effect of intervention.

Summary of findings for the main comparison. Interventions for callers to quitlines ‐ effect of additional proactive calls for smoking cessation

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Summary of findings 2. Proactive telephone counselling for smokers not calling quitlines

Proactive telephone counselling for smokers not calling quitlines
Patient or population: smokers not calling quitlines Intervention: proactive telephone counselling
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Proactive telephone counselling
Cessation at longest follow‐up ‐ All trials, subgroups by amount of control group support Self reported abstinence (majority) Follow‐up: 6+ months	97 per 1000¹	123 per 1000 (116 to 132)	RR 1.27 (1.2 to 1.36)	30246 (51 studies)	⊕⊕⊕⊝ moderate^2,3
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (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: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Based on crude average of events/total, with participants lost to follow‐up assumed to be smoking. Interquartile range in trials 6‐20%. Higher baseline cessation rates typical amongst motivated populations receiving pharmacotherapy and some support Relative addtional benefit of telephone intervention may be smaller in this setting. ² Effect estimate not sensitive to exclusion of studies without biochemical validation of abstinence. ³ In subgroup analyses, evidence of effect was clear when the control group received usual care, or brief advice or face to face counselling. Effect smaller and less certain when all participants received pharmacotherapy.

Summary of findings 2. Proactive telephone counselling for smokers not calling quitlines

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Comparison 1. Interventions for callers to quitlines ‐ effect of additional proactive calls

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cessation at longest follow‐up Show forest plot	12	30182	Risk Ratio (M‐H, Fixed, 95% CI)	1.38 [1.28, 1.49]

Comparison 1. Interventions for callers to quitlines ‐ effect of additional proactive calls

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Comparison 2. Interventions for callers to quitlines ‐ comparison of different support during a single call

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cessation at longest follow‐up Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Reactive counselling vs self‐help materials	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Stage‐based counselling versus general information	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 Tailored counselling versus standard counselling	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. Interventions for callers to quitlines ‐ comparison of different support during a single call

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Comparison 3. Offer of counselling via quitlines/helplines/hotlines

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Long term cessation Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Hotline and self‐help materials compared to self help only	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Hotline and self‐help materials for cessation maintenance compared to nothing	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 Reactive or proactive counselling vs provider counselling	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 3. Offer of counselling via quitlines/helplines/hotlines

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Comparison 4. Interventions for smokers not calling quitlines ‐ subgroups by baseline support

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cessation at longest follow‐up ‐ All trials, subgroups by amount of control group support Show forest plot	51	30246	Risk Ratio (M‐H, Fixed, 95% CI)	1.27 [1.20, 1.36]

1.1 Self‐help or minimal intervention control	30	19134	Risk Ratio (M‐H, Fixed, 95% CI)	1.34 [1.22, 1.46]
1.2 Adjunct to brief intervention or counselling	11	3520	Risk Ratio (M‐H, Fixed, 95% CI)	1.41 [1.20, 1.66]
1.3 Adjunct to pharmacotherapy	11	7592	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [1.03, 1.27]

Comparison 4. Interventions for smokers not calling quitlines ‐ subgroups by baseline support

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Comparison 5. Interventions for smokers not calling quitlines ‐ subgroups by intensity: 1‐2, 3‐6, >6 calls

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cessation at longest follow‐up Show forest plot	51	30490	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [1.20, 1.36]

1.1 Two sessions or fewer	9	6274	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.91, 1.26]
1.2 3‐6 sessions	34	19736	Risk Ratio (M‐H, Fixed, 95% CI)	1.32 [1.23, 1.42]
1.3 7 sessions or more	9	4480	Risk Ratio (M‐H, Fixed, 95% CI)	1.29 [1.11, 1.50]

Comparison 5. Interventions for smokers not calling quitlines ‐ subgroups by intensity: 1‐2, 3‐6, >6 calls

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Comparison 6. Interventions for smokers not calling quitlines ‐ subgroups by motivation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Long‐term cessation Show forest plot	51	30246	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [1.20, 1.36]

1.1 Selected for motivation/ interest in quitting	16	10612	Risk Ratio (M‐H, Fixed, 95% CI)	1.30 [1.19, 1.42]
1.2 Not selected by motivation	35	19634	Risk Ratio (M‐H, Fixed, 95% CI)	1.26 [1.16, 1.38]

Comparison 6. Interventions for smokers not calling quitlines ‐ subgroups by motivation

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Asesoramiento telefónico para el abandono del hábito de fumar

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