[Evidence Summary] Interventions for smoking cessation in hospitalised patients

Key messages

- When people who smoke are admitted to a hospital, they can be helped to quit smoking if they receive stop-smoking counselling that begins in hospital and continues for at least a month after they return home, compared to no counselling.

- Medications, such as nicotine patches and varenicline, in combination with counselling also help people quit smoking post-discharge. These treatments work better than not starting counselling or medication during a hospitalisation.

- Evidence supports hospitals and hospital clinicians offering in-hospital and post-discharge cessation support to patients, and demonstrates that patients may benefit from beginning their quit-smoking journey prior to, or upon, hospital discharge, in order to stay quit post-discharge.

What did we want to find out?

We wanted to find out what interventions are helpful to support hospitalised people who smoke in quitting cigarette smoking. Our main goal was to find out which treatments can help hospitalised patients stop smoking for at least six months. This is important because smoking contributes to many health problems, including cancers, heart disease, and lung disease. People who smoke and are admitted to a hospital to treat a medical illness, especially an illness that is related to smoking, might be more receptive to advice to quit smoking. The smoke-free hospital environment may also help them to try out not smoking and to start treatment to remain smoke-free after leaving the hospital.

What did we do?

We searched for studies that looked at stop smoking interventions (medications versus no medications or dummy pill and/or counselling versus no counselling) that began during a medical hospitalisation. Smoking cessation medications generally work to reduce withdrawal symptoms and stave off cravings; NRT by providing low levels of nicotine without the poisonous chemicals, and drugs such varenicline and bupropion, which do not contain nicotine, by directly targeting the reward and pleasure/addictive centres in the brain. Providing these treatments before someone is discharged from the hospital allows them to get a headstart on quitting smoking, as their hospitalisation is smoke-free. We looked for randomised controlled trials or quasi-randomised controlled trials, in which the treatments people received were decided at random or semi-random. Randomised studies typically give the most reliable and robust evidence about the effects of a treatment.

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