Smoking Cessation Clinical Trial
Official title:
Randomised Controlled Trial to Test the Effectiveness of an Intensive Home Support Intervention for Newly Abstinent Smokers Leaving Hospital
The present study is proposed to build on the investigators demonstration of the effectiveness of default delivery of smoking interventions in hospital inpatients by testing a multi-component intervention to prevent relapse to smoking after hospital discharge. The proposed intervention is designed to integrate easily with existing services, and hence be widely implemented if shown to be effective
The Investigators analysis of electronic primary care records has recently estimated that
approximately 1.1 million smokers are admitted to English hospitals every year . Every one of
these admissions represents a prime opportunity to intervene to promote smoking cessation,
particularly since most smokers abstain from smoking while in hospital. Recent NICE guidance
(PH48) recommends that smoking cessation interventions should be provided in routine care
pathways for all smokers admitted to hospital; The Investigators earlier work (Evaluation of
the impact of a systematic delivery of cessation interventions on delivery of smoking
cessation in secondary care. REC Reference Number:10/H0403/34) in this Programme
(RP-PG-0608-10020) has demonstrated that default delivery of cessation support to all smokers
in hospital significantly increases uptake of support and doubles the proportion of smokers
who quit long term. Clinical experience indicates that many smokers admitted to hospital,
particularly those with an illness caused or exacerbated by smoking, are motivated not to
smoke again after discharge but are also likely to be heavily dependent on smoking and in
many cases are disabled by lung or heart disease, socially isolated, and socio-economically
deprived. On leaving hospital, many participants returned to a home environment where smoking
has been an integral part of daily life for many years. It is therefore not surprising that
whilst many participants managed to stay smoke-free during their hospital stay, relapse after
discharge is common.
The Investigators previous study, among smokers who received care similar to that now
recommended by NICE, 62% of participants abstinent at discharge had relapsed by 4 weeks, and
81% by 6 months. The Investigators hypothesise that many of these relapses could be prevented
by interventions that help to sustain cessation and the maintenance of smoke-free home after
discharge.
The investigators therefore propose to test the effectiveness of an intensive home support
intervention for newly-abstinent smokers leaving hospital and involving home visits to
support cessation and establishment of a smoke-free home; ensure receipt and correct use of
smoking cessation pharmacotherapy; deliver behavioural support or else, where local services
are preferred, transfer to local community Stop Smoking Services (SSS).
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