CochraneTAG SAPC presentation 2015- Motivational Interviewing Updat

1. 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

2. • 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

3. • 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= 1.16
to 1.36)
Action

4. 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?