Background: There is insufficient and conflicting evidence about whether more intensive behavioural support is more effective than basic behavioural support for smoking cessation and whether primary care nurses can deliver effective behavioural support.
Methods: A randomised controlled trial was performed in 26 UK general practices. 925 smokers of ⩾10 cigarettes per day were randomly allocated to basic or weekly support. All participants were seen before quitting, telephoned around quit day, and seen 1 and 4 weeks after the initial appointment (basic support). Participants receiving weekly support had an additional telephone call at 10 days and 3 weeks after the initial appointment and an additional visit at 2 weeks to motivate adherence to nicotine replacement and renew quit attempts. 15 mg/16 h nicotine patches were given to all participants. The outcome was assessed by intention to treat analyses of the percentage confirmed sustained abstinence at 4, 12, 26 and 52 weeks after quit day.
Results: Of the 469 and 456 participants in the basic and weekly arms, the numbers (%) who quit and the percentage difference were 105 (22.4%) vs 102 (22.4%), 0.1% (95% CI −5.3% to 5.5%) at 4 weeks, 66 (14.1%) vs 52 (11.4%), −2.6% (95% CI −6.9% to 1.7%) at 12 weeks, 50 (10.7%) vs 40 (8.8%), −1.9% (95% CI −5.7% to 2.0%) at 26 weeks and 36 (7.7%) vs 30 (6.6%), −1.1% (95% CI −4.4% to 2.3%) at 52 weeks.
Conclusions: The absolute quit rates achieved are those expected from nicotine replacement alone, implying that neither basic nor weekly support were effective. Primary care smoking cessation treatment should provide pharmacotherapy with sufficient support only to ensure it is used appropriately, and those in need of support should be referred to specialists.
- CO, carbon monoxide
- NRT, nicotine replacement therapy
- NV, nurse visit
- TC, telephone call
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Published Online First 3 May 2007
This study was funded by a programme grant from Cancer Research UK (trial registration ISRCTN 05689186). United Pharmaceuticals supplied the nicotine patches for the study free to be given without charge to the participants.
Competing interests: PA has received free nicotine replacement products from Novartis and nortriptyline from King Pharmaceuticals for distribution to trial participants; personal income for advice to Xenova, a biotechnology company investigating a nicotine vaccine; small gifts and had numerous meals paid for by drug companies, including those producing medications for smoking cessation; and travel grants to attend conferences from the Society for Research in Nicotine and Tobacco. KB, CS and AA have received small gifts and had meals paid for by drug companies, including those manufacturing medications for smoking cessation. M Munafò has received fees for invited lectures from the National Health Service, GlaxoSmithKline, Novartis, the Moffitt Cancer Research Center and the Karolinska Instituet; benefits in kind (hospitality etc) from various pharmaceutical companies; research and travel support from the European Research Advisory Board, GlaxoSmithKline, Pfizer Consumer Healthcare and Novartis; and he has acted as a consultant to the European Commission, The American Institutes for Research, the National Audit Office and G-Nostics Ltd. EJ has received consultancy income from the European Network for Smoking Prevention. M Murphy has received consultancy income from the European Network for Smoking Prevention and has provided scientific consultancy services through the University of Oxford ISOS Innovation to the National Audit Office and G-Nostics Ltd. The Childhood Cancer Research Group and the Cancer Research UK General Practice Research Group have received unrestricted educational grants, research project grants and consultancy fees from Ciba Geigy/Novartis, Glaxo Smith Kline, Pharmacia/Pfizer, Ares-Serono, Sanofi-Synthelabo, Third Wave Technologies, Astra-Zeneca and G-Nostics.
A longer version of this paper can be obtained by emailing Paul Aveyard.
The protocol was designed and written by Mike Murphy, Marcus Munafò, Robert Walton, Mike Bradburn, Ed Peile and Mark Drury. The clinical protocol was designed by Mark Drury, Karen Brown and Mike Murphy. Karen Brown and Cas Saunders recruited and trained the practice nurses. Karen Brown, Cas Saunders and Avril Alexander monitored the practice nurses. Kate Hey provided orgnanisational and computing support. Viv Crombie and Victoria Johansen provided administrative support. Elaine Johnstone, Katherine Elliott and Dominic Sweeney processed the samples. The cotinine concentrations were measured by ABS Labs Ltd, London. Karen Brown, Mark Drury and Paul Aveyard monitored the study. Mike Bradburn, Louise Linsell and Sharon Love provided statistical support. Paul Aveyard cleaned and analysed the data and wrote the first draft of the study. All authors commented and revised the draft and it was agreed by all authors. Paul Aveyard acts as the guarantor of the study.
The smoking cessation coordinators of Milton Keynes (Pam Berry), Buckinghamshire (Jane Giles, Val Mills) and Oxfordshire (Laura Wardak) Stop Smoking Services provided valuable support. The following nurses and surgeries participated in the clinical care of patients: Edwina Humm, Mill Stream Surgery, Benson; Lesley Boler, Church Street Practice, Wantage; Sheila Long, 19 Beaumont Street, Oxford; Lesley Cook, Temple Cowley Health Centre, Oxford; Fran Kelly, Donnington Health Centre, Oxford; Sue Lynch, Health Centre, Bicester; Louise Ross, Aston Clinton Surgery, Aston Clinton; Louise Ross, Wendover Health Centre, Wendover; Nicole Coulon, Jericho Health Centre, Oxford; Kathy Gould, The Health Centre, Thame; Dianne Alley, Boughton House Surgery, Aylesbury; Avril Alexander, Bury Knowle Health Centre, Oxford; Jenny Molloy, Oakfield Health Centre, Aylesbury; Ruth Dowthwaite, Poplar Grove Practice, Aylesbury; Chris Townsend, Bedgrove Surgery, Bedgrove; Lynn Murphy, Whitehill Surgery, Aylesbury; Avril Alexander, The Malthouse, Abingdon; Avril Alexander and Cas Saunders, The Health Centre, Didcot; Chris Malins and Cas Saunders, Marcham Road Health Centre, Abingdon; Karen Brown, Woodstock Surgery, Woodstock; Val Lewis, Blackbird Leys Health Centre; Avril Alexander, Mably Way Surgery, Wantage; Ruth Thompsett, Central Milton Keynes Surgery, Milton Keynes; Mary Ellis, Bedford Street Surgery, Milton Keynes; Avril Alexander, Central Oxford Research Clinic; Avril Alexander, Bloxham Surgery, Bloxham.
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