Randomized trial of telephone counselling in association with the Guide Your Parents to a Smoke-Free Future program

Abstract

Objective: To evaluate the incremental benefit of telephone counselling in association with the Guide Your Patients to a Smoke-Free Future program.

Design: Clinical trial with stratification (by gender & degree of nicotine dependence) and random assignment to Guide Your Patients (GYP) or Guide Your Patients+ Telephone Counselling (GYP+TC) group.

Setting: Smoking Cessation Clinic at the Ottawa Heart Institute.

Participants: Volunteer sample of 396 smokers(~ 15 cigarettes/day), free of major health problems, interested in quitting smoking within 30 days.

Interventions: Physician advice on three occasions according to the Guide Your Patients handbook, self-help materials and 12 weeks of nicotine replacement therapy, with ( Guide Your Patients+ Telephone Counselling group), or without (Guide Your Patients group) nurse-mediated telephone counselling two, six, and 13 weeks after a target quit date.

Main Outcome :Measures: Smoking status (point-prevalent abstinence, continuous abstinence, and time to relapse) at 26-week follow-up; processes of change, self-efficacy. and perceived stress at baseline, four and 12 weeks after target quit date.

Results: There was no difference in the 26-week point prevalent abstinence rate (29 .6% vs. 26.9%; P-Value=.54) or continuous abstinence rate (25.6% vs. 25.4%; P Value=.96) between the Guide Your Patients and Guide Your Patients+ Telephone Counselling groups, respectively. Survival analysis showed no difference between the relapse curves for the two groups (median time to relapse= I IO vs. 92 days; P-V aJue=. lO). Survival analysis within subgroups revealed an unexpected reduction in the survival function for low nicotine-dependent males receiving telephone counselling (median time to relapse= 99 vs. 187 days; P-Value=.0l).

Repeated measures ANOVA analysis of process of change data revealed significant increases in the use of consciousness raising, self-liberation, counterconditioning, stimulus control reinforcement management, and helping relationships over time, but no significant interactions between treatment condition and changes in use of processes of change. Successful quitters endorsed significantly less use of self-reevaluation and greater use of counterconditioning and helping relationships.

Repeated measures ANOVA analysis of self-efficacy data revealed significant increases in total confidence and confidence in social, negative affect and habitual situations over time during treatment, but no effect of treatment condition. Successful quitters had significantly higher levels of total confidence and confidence in social. negative affect and habitual situations over time during treatment.

Perceived stress during treatment was unaffected by the treatment group assignment. Successful quitters had significantly lower levels of perceived stress at baseline and four and 12 weeks after the target quit date.

Logistic regression analysis revealed three significant univariate baseline predictors of cessation: level of nicotine dependence: education level: and perceived stress. The odds of being abstinent at 26-week follow-up were increased by having more than a high school education (OR: 959c CI=2.3: l.44. 3.68). The odds of being abstinent were reduced by having a Fagerstrom Tolerance Questionnaire Score 2:: 7 (OR; 95lk CI= 0.63: 0.40. 0.99) or a Perceived Stress Score 2:: 8 (OR: 95Ck CI = 0.39: 0.22. 0.69).

Conclusions: Physician assistance, using the Guide Your Patients program. and incorporating nicotine replacement therapy. is enough to help many smokers. Quit rates are not improved by additional nurse-mediated telephone counselling. Telephone counselling may be counterproductive in low nicotine-dependent males. Telephone counselling did not incrementally enhance the stage appropriate use of processes of change or the development of self-efficacy. This study does not rule out the possibility that telephone counselling may benefit smokers in earlier stages of preparedness to quit. smokers receiving less intense intervention or less than optimal assistance from their physician, or smokers who self-select telephone counselling. This study also does not rule out the possibility that a different telephone intervention or altered timing of the calls could have yielded different results.