Efficacy of a short-term residential smoking cessation therapy versus standard outpatient group therapy ('START-Study'): study protocol of a randomized controlled trial

Abstract

Background: In Germany, evidence-based outpatient smoking cessation therapies are widely available. Long-term abstinence rates, however, are limited. Studies suggest that short-term residential therapy enables a higher level of environmental control, more intense contact and greater support among patients and from therapists, which could result in higher abstinence rates. The aim of the current START-study is to investigate the long-term efficacy of a short-term residential therapy exclusively for smoking cessation, conducted by a mobile team of expert therapists.

Methods: A randomized controlled trial (RCT) is conducted to examine the efficacy of residential behavior therapeutic smoking cessation therapy compared to standard outpatient behavior therapeutic smoking cessation group therapy. Adult smokers consuming 10 or more cigarettes per day, who are willing to stop smoking, are randomized in a ratio of 1:1 between therapy groups. The primary endpoint is sustained abstinence for 6-month and 12-month periods. Secondary endpoints include smoking status after therapy, 7-day point abstinence after the 6-month and 12-month follow-ups, level of physical dependence, cost-effectiveness, use of nicotine replacement products, health-related quality of life, self-efficacy expectation for tobacco abstinence, motivational and volitional determinants of behavior change, self-reported depressive symptom severity, adverse events and possible side effects. Assessments will take place at baseline, post-therapy, and at 6-month and 12-month intervals after smoking cessation.

Discussion: There is a high demand for long-term effective smoking cessation therapies. This study represents the first prospective RCT to examine the long-term efficacy of a residential smoking cessation therapy program compared to standard outpatient group therapy as an active control condition. The residential therapeutic concept may serve as a new model to substantially enhance future cessation therapies and improve the understanding of therapeutic impact factors on tobacco abstinence. Utilizing a mobile team, the model could be applied efficiently to medical centers that do not have permanent and trained personnel for smoking cessation at their disposal.

Trial registration: German Register for Clinical Trials (Deutsches Register für Klinische Studien), DRKS00013466. Retrospectively registered on 1 April 2019. https://www.drks.de/drks_web/navigate.do?navigationId=start.

Keywords: Behavioral therapy; Inpatient; Motivational interviewing; Outpatient group therapy; Prevention; Randomized controlled trial; Residential; Smoking cessation.

Fig. 1

Flow chart of inclusion and study procedure

Fig. 2

SPIRIT schedule of enrollment, interventions, and assessments. Abbreviations. t-1 enrollment, t0 baseline-assessment, Al./Iv. allocation/intervention, t1 post-assessment after completion of therapy, t2 6-month follow-up-assessment, t3 12-month follow-up-assessment, FTND Fagerström Test for Nicotine Dependence, SER Selbstwirksamkeits-Skala zur Raucherentwöhnung (engl. self-efficacy scale for smoking abstinence), HAPA Health Action Process Approach, EQ-5D-5L EuroQol 5-dimensions questionnaire for the assessment of health-related quality of life [, , –60]