Clinical question:
How effective is smoking advice alone from physicians in promoting smoking cessation?
Bottom line:
How effective is smoking advice alone from physicians in promoting smoking cessation? Physician advice has a small effect on smoking cessation rates. Assuming an unassisted quit rate of 2% at 12 months in a population of primary care attenders, minimal advice intervention can increase quitting by a further 1 to 3% (median NNT* 34). Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions, including use of aids and more intensive behavioural counselling, compared to very brief interventions. Providing follow-up support after offering the advice may increase the quit rates slightly (median NNT16).
*NNT = number needed to treat to benefit one individual
Caveat:
Included studies required a minimum follow-up of at least six months. Trials were excluded if they involved advice plus some form of nicotine replacement therapy, or where advice to stop smoking was included as part of multifactorial lifestyle counselling (eg, including dietary and exercise advice). There was insufficient evidence to draw any conclusions about the effect of motivational as opposed to simple advice, or between different advice-giving styles. Only two studies determined the effect of smoking advice on mortality – there was no statistically significant difference in death rates at 20 years follow-up between those given advice and those given no advice or usual care.
Context:
Healthcare professionals frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions.
Cochrane Systematic Review:
Stead LF et al. Physician advice for smoking cessation. Cochrane Reviews 2008, Issue 1. Art. No.: CD000165. DOI:10.1002/14651858.CD000165.pub3. This review contains 41 trials, conducted between 1972 and 2007, involving over 31,000 smokers.
