Stop-smoking counseling: more effective than thought
Study: Physician input makes a difference
While it might seem that physician lectures to patients about the dangers of smoking are falling on deaf ears, experts in the United States and England say doctors who take a few minutes to talk with patients about their smoking really do make a difference when it comes to helping them quit successfully.
"Assuming an unassisted quit rate of 2 to 3 percent, a brief advice intervention can increase quitting by a further 1 to 3 percent," writes researcher Lindsay Stead, MA, MSc, of the University of Oxford in England, in Cochrane Database of Systematic Reviews. 1
A team of researchers looked at 41 studies of more than 31,000 smokers, and found that the impact of physician advice is perhaps more than expected.
"To a non-clinician, these results may seem underwhelming, but [they] are really quite significant when you consider how many people who smoke see a physician every year — about 80 percent — and how many more of them would quit if all doctors advised them to do so at every visit," comments Abigail Halperin, MD, a University of Washington physician and researcher who specializes in prevention and treatment of tobacco-related diseases. Halperin was not a participant in the published review.
The reviewers looked at studies conducted between 1972 and 2007. When they pooled data from 17 trials of brief advice compared to no advice, they found significant increases in quit rate among the group that got some kind of counsel from a physician.
Efforts did not have to be lengthy or complicated: The researchers found no statistical difference between intensive and minimal endeavors. However, the studies did not select study participants based on motivation to quit smoking, which might have affected the findings on intensive interventions.
"Cessation interventions are typically highly cost-effective, so even a very small improvement in effect from intensifying the intervention could well be cost-effective," says Stead.
Halperin points out that there are still some 45 million smokers in the United States, and about 70% of them say they want to quit.
"Of these, about half try to quit and less than 5% are successful. If we assume that half of these patients are advised by their [physician] to quit smoking now — a generous estimate — and that 2% more would quit if they were all advised to, then we could see an additional 720,000 smokers become nonsmokers each year," Halperin suggests. "This would have a huge impact on public health, since tobacco-related diseases are by far the nation's largest contributor to disability and premature death – not to mention health care costs."
The majority of smokers require not one, but several quit attempts, to stop smoking for good. Stead says once a doctor identifies a patient as a smoker and discovers that he or she is willing to make a quit attempt, then follow-up and referral — in addition to a brief intervention — can help ensure success.
Persistence is important, Halperin stresses, because only a small percentage of people who quit remain nonsmokers beyond six months to one year without additional help.
"In the two programs where I work, we assist patients in developing a quit plan, provide practical counseling, and prescribe nicotine replacement therapy or other medication to ameliorate withdrawal symptoms, and are seeing 25- to 35-percent quit rates," she reports. "These steps can be accomplished by any physician or other health care provider, or by referring the patient to a telephone quit line or other program that provides this kind of evidence-based support."
Stead says a barrier to providing intensive intervention to all patients, even smokers who are initially resistant to the idea, may be that physicians don't believe it can be as effective as the review shows it to be.
Reference
- Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation (Review). Cochrane Database of Systematic Reviews 2008, Issue 2. Available online at: www.cochrane.org/reviews/en/ab000165.html.
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