Hanna Dutt, Arleigh Dean, Rayyan Syed Kamal, Alison L Allan
Importance of Incorporating the Perspectives of People with Cancer into Oncology Education: A Scoping Review
Journal of medical education and curricular development
2020 326 worlds population used tobacco smoking contributes many illnesses require hospitalisation hospital admission may prompt quit attempt initiating smoking cessation treatment pharmacotherapy andor counselling hospitals may effective preventive health strategy pharmacotherapies work reduce withdrawalcraving counselling provides behavioural skills quitting smoking review updates evidence interventions smoking cessation hospitalised patients understand effective smoking cessation treatment methods hospitalised smokers assess effects type smoking cessation programme patients admitted acute care hospital used standard extensive cochrane search methods latest search date 7 september 2022 included randomised quasirandomised studies behavioural pharmacological multicomponent interventions help patients admitted hospital quit interventions start hospital including discharge people smoked within last month excluded studies psychiatric substance rehabilitation centres well studies measure abstinence six months longer used standard cochrane methods primary outcome abstinence smoking assessed least six months discharge start intervention used rigorous definition abstinence preferring biochemicallyvalidated rates reported used grade assess certainty evidence included 82 studies 74 rcts included 42273 participants review 71 studies 37237 participants included metaanalyses 36 studies new update rated 10 studies low risk bias overall low risk domains assessed 48 high risk bias overall high risk least one domain remaining 24 unclear risk cessation counselling versus counselling grouped intensity intervention hospitalised patients received smoking cessation counselling began hospital continued month discharge higher quit rates patients received counselling hospital following hospitalisation risk ratio rr 136 95 confidence interval ci 124 149 28 studies 8234 participants highcertainty evidence absolute terms might account additional 76 quitters every 1000 participants 95 ci 51 103 evidence uncertain lowcertainty effects counselling interventions less intensity shorter duration inhospital counselling 15 minutes rr 152 95 ci 080 289 2 studies 1417 participants inhospital contact plus followup counselling support 1 month rr 104 95 ci 090 120 7 studies 4627 participants versus counselling moderatecertainty evidence limited imprecision smoking cessation counselling least 15 minutes hospital without postdischarge support led higher quit rates counselling hospital rr 127 95 ci 102 158 12 studies 4432 participants pharmacotherapy versus placebo pharmacotherapy nicotine replacement therapy helped patients quit placebo pharmacotherapy rr 133 95 ci 105 167 8 studies 3838 participants highcertainty evidence absolute terms might equate additional 62 quitters per 1000 participants 95 ci 9 126 moderatecertainty evidence limited imprecision ci encompassed possibility difference varenicline helped hospitalised patients quit placebo pharmacotherapy rr 129 95 ci 096 175 4 studies 829 participants evidence bupropion lowcertainty point estimate indicated modest benefit best cis wide incorporated clinically significant harm clinically significant benefit rr 111 95 ci 086 143 4 studies 872 participants hospitalonly intervention versus intervention continues hospital discharge patients offered smoking cessation counselling pharmacotherapy discharge higher quit rates patients offered counselling hospital offered postdischarge support rr 123 95 ci 109 138 7 studies 5610 participants highcertainty evidence absolute terms might equate additional 34 quitters per 1000 participants 95 ci 13 55 postdischarge interventions offering realtime counselling without pharmacotherapy rr 123 95 ci 095 160 8 studies 2299 participants low certaintyevidence offering unscheduled counselling without pharmacotherapy rr 097 95 ci 083 114 2 studies 1598 participants lowcertainty evidence may little effect quit rates compared control telephone quitlines versus control provide postdischarge support hospitals may refer patients communitybased telephone quitlines comparisons relating interventions wide cis encompassing possible harm possible benefit judged low certainty due imprecision inconsistency risk bias postdischarge telephone counselling versus quitline referral rr 123 95 ci 100 151 3 studies 3260 participants quitline referral versus control rr 117 95 ci 070 196 2 studies 1870 participants offering hospitalised patients smoking cessation counselling beginning hospital continuing one month discharge increases quit rates compared hospital intervention counselling provided hospital without postdischarge support may modest impact quit rates evidence less certain patients receive counselling hospital highcertainty evidence indicates providing counselling pharmacotherapy discharge increases quit rates compared postdischarge intervention starting nicotine replacement varenicline hospitalised patients helps patients quit smoking placebo medication though evidence varenicline moderatecertainty due imprecision less evidence benefit bupropion setting evidence limited imprecision bupropion versus placebo varenicline versus placebo risk bias inconsistency related heterogeneity future research needed identify effective strategies implement disseminate sustain interventions ensure cessation counselling pharmacotherapy initiated hospital sustained discharge