Abstract

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 In this randomised controlled trial in 26 UK general practices, 925 smokers of 10 or more cigarettes per day were randomly allocated to basic or weekly support. All participants were seen prior to quitting, telephoned around quit day, and seen one and four weeks after initial appointment (basic support). In weekly support, participants had an additional telephone call at 10 days and three weeks after initial appointment and an additional visit at 2 weeks to motivate adherence to nicotine replacement and renew quit attempts. 15mg/16 hour 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 (percentages) quit and the percentage difference (95% confidence intervals) were 105 (22.4), 102 (22.4), 0.1 (-5.3-5.5) at 4 weeks, 66 (14.1), 52 (11.4), -2.6 (-6.9-1.7) at 12 weeks, 50 (10.7), 40 (8.8), -1.9 (-5.7-2.0) at 26 weeks, and 36 (7.7), 30 (6.6), -1.1 (-4.4-2.3) 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 refer those in need of support to specialists.