Motivational interviewing for

smoking cessation

A Cochrane review update

Lindson-Hawley N; Thompson T; Begh R

Dr Nicola Lindson-Hawley

Cochrane Tobacco Addiction Group Managing Editor

Nuffield Department of Primary Care Health Sciences

University of Oxford

nicola.lindson-hawley@phc.ox.ac.uk

44th SAPC ASM; Oxford 2015

• Tobacco smoking is still a public health problem and we are still searching for effective ways to help people to stop

• Motivational interviewing (MI):

– first described by Miller (1983)

– client-centred counselling

– helps people explore & resolve ambivalence

– guides person toward behaviour change without confrontation

• Systematic reviews have found MI is an effective intervention for many behaviours, such as weight control, alcohol use, medication adherence

• We aim to examine whether smokers receiving MI are more likely to quit than those receiving usual cessation care or brief advice

Aim

• Cochrane systematic review and meta-analysis update– last updated 2010

– updated searches Nov 2014; doubled included studies from 14 to 28

– N = 16,803

– MI compared to brief advice or usual care

– MI carried out in 1 - 6 sessions; each session 10-60mins; 7 trials over the telephone, 21 face-to-face; delivered by range of providers

• Modest, significant benefit of MI. 30% more quitters at 6 month follow-up (RR= 1.26; 95% CI= 1.16to 1.36)

Action

There is evidence MI may be most successful in promoting smoking cessation when delivered…

...by GPs (RR= 3.49; 95% CI= 1.53 to 7.94), but this should be investigated further as is only based on 2 studies

...in fewer, shorter sessions (<20mins: RR= 1.69; 95% CI= 1.34 to 2.12). One short session could be enough to increase motivation. Prolonging session/time to quit may mean participants lose focus

However

• Overall benefit of MI over usual care is less than found with individual and group counselling programmes (Lancaster & Stead 2005; Stead & Lancaster 2005)

• Studies with negative/inconclusive findings may be under-represented; and there was evidence of between study heterogeneity

• Future trials should aim for greater clarity and consistency of methods so we can pick apart under what circumstances MI may be most useful

Application?