Nursing interventions for smoking cessation

Background Healthcare professionals, including nurses, frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. Objectives To determine the effectiveness of nursing‐delivered smoking cessation interventions in adults. To establish whether nursing‐delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow‐ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking. Search methods We searched the Cochrane Tobacco Addiction Group Specialized Register and CINAHL in January 2017. Selection criteria Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow‐up of at least six months. Data collection and analysis Two review authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow‐up. We used the most rigorous definition of abstinence for each trial, and biochemically‐validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel‐Haenszel fixed‐effect model and reported the outcome as a risk ratio (RR) with a 95% confidence interval (CI). Main results Fifty‐eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I2 = 50%) and not explained by subgroup analysis. Because of this, we judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, we did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. Subgroup analyses found no evidence that high‐intensity interventions, interventions with additional follow‐up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow‐up or aids. There was no evidence that the effe