Management of smoking in primary care (MaSC), Version 1.0
Research type
Research Study
Full title
A randomised controlled trial on the effectiveness of GP/nurse promotion of e-cigarettes in supporting reduced smoking and abstinence in hardcore smokers with smoking-related chronic disease
IRAS ID
226445
Contact name
Rachna Begh
Contact email
Sponsor organisation
University of Oxford
Duration of Study in the UK
2 years, 1 months, 15 days
Research summary
Research Summary
Smoking remains the leading cause of preventable illness and death in England. Evidence shows that brief advice to stop smoking from a GP together with an immediate offer of support is effective at encouraging smokers to quit. Despite this, many people with smoking-related chronic illnesses continue to do so despite being repeatedly offered help to quit. For these ‘hardcore’ smokers, alternative brief advice interventions need to be explored. Electronic cigarettes (‘e-cigarettes’) are increasingly used by smokers not seeking treatment, many of whom reduce smoking and stop without initially intending to do so. The aim here is to test an alternative approach to smoking management designed to support people who have a smoking-related illness reduce their smoking and quit. GPs and nurses will receive online training on how to give a brief advice intervention to smokers who do not want to stop but have a smoking-related illness. Patients who are smokers with a long-term condition will attend their usual annual review appointment of their condition, where the GP or nurse will discuss their smoking. Patients will be randomised into one of two groups if they decline referral to NHS stop smoking services (SSS) and smoking cessation medication: a control group who will receive nothing beyond the usual care already provided prior to randomisation or an intervention group who are given brief advice and an offer to try an e-cigarette with technical support provided from an online help forum and telephone call-back service run by experienced e-cigarette users. Consultations will be audio-recorded to see how well GPs and nurses followed the training and which communication strategies worked well. Patients will be interviewed after taking part to see how they felt about being assisted in this way by their GP or nurse. The study will look at whether more people stop or halve their smoking in the short-term.Summary of Results
Background and study aims Smoking remains the leading cause of preventable illness and death in England. Evidence shows that brief advice to stop smoking from a GP together with an immediate offer of support is effective at encouraging smokers to quit. Despite this, many people with smoking-related chronic illnesses continue to do so despite being repeatedly offered help to quit. For these ' hardcore' smokers, alternative approaches to offering brief advice and support need to be explored. Electronic cigarettes ('e-cigarettes') are increasingly used by smokers not seeking treatment, many of whom reduce smoking and stop without initially intending to do so. The aim of this study was to test the offer of e-cigarettes as an alternative approach to smoking management to support people who have a smoking-related illness reduce their smoking and quit.Methods
Patients who were smokers with a long-term condition attended their usual annual review appointment of their condition, where the GP or nurse discussed their smoking. Those who declined referral to NHS stop smoking services and smoking cession medication were randomly allocated to one of two groups. One group (the 'control' group) received nothing beyond the usual care already provided. Those in the other group (the e-cigarette group) were given brief advice and an offer to try an e-cigarette, together with an information booklet and telephone support from experienced e-cigarette users. We contacted participants again 2 months and 8 months after their annual review to record whether they had reduced their smoking and quit.Results
We recruited 325 participants in total from across 39 general practices in the UK. There were 164 participants in the e-cigarette group and 161 participants in the control group. We were able to contact 96% of participants again after 2 months of seeing them at their annual review appointment and 90% of participants after 8 months. The majority of participants in the e-cigarette group (148 out of 164) accepted the offer of an e-cigarette from their GP or nurse. Approximately half of those in the e-cigarette group were still using it daily or weekly after 2 months, while a third of participants were doing so after 8 months. At 2 months, participants in the e-cigarette group were three times more likely to reduce their smoking by at least half the amount they used to smoke compared with the control group. There was no difference between groups in the amount they reduced their smoking at 8 months. Only few participants stopped smoking after 2 months and 8 months, with more people quitting in the e-cigarette group, but the numbers were too small overall for any difference between groups.Conclusions
This research shows that it is possible to train GPs and nurses to give brief advice about e-cigarettes and offer them to smokers who do not want to stop smoking. Most people were willing to try an e-cigarette despite having initially refused other stop smoking treatments. This approach led to more people reducing the amount they smoked. A larger study will be needed to determine whether this approach can lead to more people quitting.REC name
Wales REC 4
REC reference
17/WA/0352
Date of REC Opinion
15 Nov 2017
REC opinion
Further Information Favourable Opinion