When Doctors Tell Patients To Quit Smoking, They Listen

Main Category: Smoking / Quit Smoking
Also Included In: Primary Care / General Practice;  Public Health
Article Date: 30 Apr 2008 - 0:00 PDT

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Doctors who take a few minutes to talk with patients about their smoking maybe passing along a leaflet or a sample of nicotine gum make a difference when it comes to helping them quit successfully, according to a recent review of studies.

"Assuming an unassisted quit rate of 2 to 3 percent, a brief advice intervention can increase quitting by a further 1 to 3 percent," write reviewers led by Lindsay Stead, of the University of Oxford in England.

Stead and his team looked at of 41 studies of more than 31,000 smokers.

"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," said Abigail Halperin, M.D.

Halperin, a physician-researcher specializing in prevention and treatment of tobacco-related diseases at the University of Washington, is not affiliated with the review.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

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," said Stead, a review group coordinator at Oxford's Department of Primary Health Care.

Halperin said that there are still some 45 million smokers in the United States and about 70 percent of them say they want to quit. "Of these, about half try to quit and less than 5 percent are successful. If we assume that half of these patients are advised by their M.D. to quit smoking now a generous estimate and that 2 percent more would quit if they were all advised to, then we could see an additional 720,000 smokers become nonsmokers each year."

"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," Halperin said.

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.

Only a small percentage of people who quit remain nonsmokers beyond six months to one year without additional help, according to Halperin. "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 said.

"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," she added.

"I suspect the barrier to providing intensive interventions to all comers including smokers who were initially resistant to the idea of a quit attempt would be that physicians would be hard to persuade it was effective," Stead said.

Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation (Review). Cochrane Database of Systematic Reviews 2008, Issue 2.

The Cochrane Collaboration is an international non-profit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

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