Interventions in the preoperative clinic for long term smoking cessation: A quantitative systematic review

Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
Canadian Journal of Anaesthesia (Impact Factor: 2.53). 06/2008; 55(1):11-21. DOI: 10.1007/BF03017592
Source: PubMed


To assess the efficacy of interventions offered to patients in the preoperative clinic to promote long-term (> or = three months) smoking cessation following surgery.
We searched The Cochrane Library, MEDLINE, EMBASE and CINAHL for all randomized controlled trials (RCTs) on smoking-cessation interventions initiated in the preoperative clinic. Trial inclusion, quality assessment, and data extraction were performed independently by two authors. Standard meta-analytic techniques were applied.
Four RCTs (n = 610 patients) were included in the review. Interventions included pharmacotherapy, counseling, educational literature and postoperative telephone follow-up. The follow-up period ranged between three to 12 months with only one RCT following up patients for > one year. Two studies used biochemical methods to validate subjects' self-reporting of smoking cessation at the follow-up assessment. Overall, the interventions were associated with a significantly higher cessation rate vs control at the three to six month follow-up period (pooled odds ratio: 1.58, 95% confidence interval (CI) 1.02-2.45, P value = 0.01, I(2) = 0%). The only trial with longer follow-up period (12 months), however, failed to show any significant difference between the intervention and control groups (odds ratio: 1.05, 95% CI 0.53-2.09, P value = 0.88).
This systematic review suggests that smoking-cessation interventions initiated at the preoperative clinic can increase the odds of abstinence by up to 60% within a three- to six-month follow-up period. To evaluate the possibility of longer abstinence, future trials with at least one-year follow-up are recommended.

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Available from: Frances Chung, Aug 15, 2014
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    • "Finally, the selection based on full text resulted in a total number of 23 systematic reviews: 14 on smoking cessation (Windsor et al., 1998; Revere and Dunbar, 2001; van der Meer et al., 2001; Blenkinsopp et al., 2003; Lumley et al., 2004; Sinclair et al., 2004; Lancaster and Stead, 2005; Rice and Stead, 2006; Rigotti et al., 2007; Barth et al., 2008; Naughton et al., 2008; Rice and Stead, 2008; Stead et al., 2008; Zaki et al., 2008) 6 on exercise promotion (Eakin et al., 2000; Pinto et al., 2000; Lawlor and Hanratty, 2001; Eden et al., 2002; Levack et al., 2006; Hudon et al., 2008), 2 on healthy diets (Thompson et al., 2003; Nield et al., 2008) and 1 on both exercise and diets (Wilcox et al., 2001; Thompson et al., 2003; Nield et al., 2008). "
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    ABSTRACT: To identify the evidence for the effectiveness of behaviour change techniques, when used by health-care professionals, in accomplishing health-promoting behaviours in patients. Reviews were used to extract data at a study level. A taxonomy was used to classify behaviour change techniques. We included 23 systematic reviews: 14 on smoking cessation, 6 on physical exercise, and 2 on healthy diets and 1 on both exercise and diets. None of the behaviour change techniques demonstrated clear effects in a convincing majority of the studies in which they were evaluated. Techniques targeting knowledge (n = 210 studies) and facilitation of behaviour (n = 172) were evaluated most frequently. However, self-monitoring of behaviour (positive effects in 56% of the studies), risk communication (52%) and use of social support (50%) were most often identified as effective. Insufficient insight into appropriateness of technique choice and quality of technique delivery hinder precise conclusions. Relatively, however, self-monitoring of behaviour, risk communication and use of social support are most effective. Health professionals should avoid thinking that providing knowledge, materials and professional support will be sufficient for patients to accomplish change and consider alternative strategies which may be more effective.
    Full-text · Article · Jun 2011 · Health Promotion International

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