Sending smoke signals. An RCT evaluating nurse-led smoking cessation interventions in secondary care.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity & mortality worldwide & is predominantly caused by smoking (NICE, 2004; West et al 2000). Smoking cessation is the only disease modifying intervention available for this population. Despite numerous systematic reviews on cessation interventions, there is a dearth of evidence evaluating nurse-led interventions for smokers with COPD. Following the publication of the BTS smoking cessation guidelines (Raw et al, 1998), a need to evaluate their efficacy was identified. Aim: The primary aim of this study was to examine the effectiveness of selected nursing interventions on the smoking behaviour of adults with COPD attending secondary care. Method: A randomised controlled trial compared the effectiveness of brief advice (usual care), individual nurse support and group support facilitated by nurses. Smoking status was biochemically validated at 2, 3, 6, 9 & 12 months. Intention to treat analysis was applied. Results: Following 28 months of recruitment, 91 subjects participated in the study (mean age 61yrs, 44 male). The sample consisted of established smokers (mean 44 pack years). After 12 months cessation rates were not significantly different between groups but all groups reported a significant reduction in nicotine addiction (p=0.03). The usual care (p=0.001) and group support (p=0.007) groups reported significant reductions in carbon monoxide levels. Conclusion: After one year patients were unable to stop smoking regardless of the support they received but many made significant reductions to their smoking habit. The researcher will explore the potential for nursing interventions in the future with this population. The researcher will also use her experience to discuss the merits of number methods to validate smoking status and how these can influence the results of a clinical trial. The issue of attrition and its impact on statistical analysis will also be discussed.