A stop-smoking strategy after cervical cancer screening: Results of a cluster-randomised controlled trial in Dutch general practice.

Abstract

Introduction: This study aimed to assess whether brief stop-smoking advice given to women who smoke and visit their general practice for cervical cancer screening improves smoking cessation outcomes.

Methods: This two-arm cluster-randomised controlled trial was conducted in 75 Dutch general practices. Participants in the intervention group received brief stop-smoking advice based on the Ask-Advise-Connect method, delivered by a practice assistant. Patient-reported outcomes were measured at 6 months: undertaking a serious quit attempt of at least 24 hours during follow-up (primary outcome), 7-day point prevalence abstinence (PPA) at 6 months, reduction in number of cigarettes smoked, increase in motivation to quit smoking, exposure to advice or support, and other psychological and behavioural measurements.

Results: There was no significant difference in undertaking a serious quit attempt between the intervention (39.8% of n=266) and control group (36.0% of n = 214), OR 1.18 (95% CI: 0.80-1.72, P=0.41). Neither did the PPA significantly differ between groups: 21.1% vs. 16.3%, OR 1.38 (95% CI: 0.83-2.29, P=0.21). Although nonsignificant, the direction of effects for the aforementioned outcomes was in favour of the intervention group. The reduction in number of cigarettes smoked and increase in motivation to quit did not differ between groups. The uptake of cessation counselling was higher in the intervention (14.7%) than in the control group (2.8%).

Conclusions: A brief stop-smoking strategy after the smear test for cervical screening might encourage women who smoke to attempt quitting and seek cessation counselling, but a significant effect could not be demonstrated in this trial.

Implications: The results of this cluster randomised trial suggest that brief advice to stop-smoking delivered by a practice assistant after routine cervical screening in general practice might encourage women who smoke to attempt quitting, but a significant effect could not be proven. Also, women who receive advice show a higher uptake of professional cessation counselling compared to their controls. Providing brief advice after the cervical smear might therefore be an useful opportunistic approach to stimulate cessation in women who smoke.