Effectiveness of nurse-led smoking cessation interventions in smoking patients: A systematic review and network meta-analysis of randomized controlled trials

Abstract

Background: Tobacco use reduces quality of life and life expectancy in all patients. Nurse is the largest group of healthcare professionals, and nurse-led smoking cessation interventions are effective for smoking patients.

Objective: To evaluate and compare the effectiveness of various nurse-led interventions on smoking cessation among patients.

Methods: PubMed, Web of Science, CINAHL, Embase, PsycINFO, Scopus, and the Cochrane Central Register of Controlled Trials were searched from inception until May 10, 2025. Randomized controlled trials (RCTs) conducted in smoking patients who received nurse-led smoking cessation interventions were included. Primary outcome was self-reported or validated tobacco abstinence prevalence at the last follow-up. Secondary outcomes included abstinence within or beyond 6 months. The revised Cochrane risk-of-bias tool was used to assess the risk of bias and the credibility of evidence using the CINeMA. Risk ratios (RR) were used to compare the effect sizes of different comparisons. Network meta-analyses were performed with random-effect models. This study was reported following the PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions.

Results: Of 3512 studies initially identified, 26 RCTs with 14,367 smoking patients were included, and eight intervention combinations were identified. Intensive counseling + varenicline (RR = 2.78, 95 % CI [1.95, 3.95], moderate certainty), intensive counseling + family-based intervention (RR = 2.68, 95 % CI [1.63, 4.39], moderate certainty), intensive counseling + nicotine replacement therapy (RR = 1.38, 95 % CI [1.08, 1.77], low certainty), and intensive counseling (RR = 1.17, 95 % CI [1.01, 1.36], very low certainty) were superior to brief advice. Brief advice (RR = 1.51, 95 % CI [1.12, 2.02]) and brief counseling (RR = 1.54, 95 % CI [1.13, 2.09]) were superior to usual care with low evidence. The surface under the cumulative ranking curve showed that intensive counseling + varenicline (99.6 %) and intensive counseling + family-based intervention (99.7 %) are the strongest intervention to increase tobacco abstinence prevalence within and beyond 6 months, respectively.

Conclusions: Nurses should incorporate brief advice or brief counseling in their routine care for smoking patients. Intensive counseling plus varenicline, nicotine replacement therapy or family-based intervention are the optimal nurse-led interventions for smoking cessation. The certainty of evidence for these interventions was generally very low to moderate. More high-quality research is warranted to ascertain the findings.

Registration: The study protocol was registered at PROSPERO (Registration number: CRD42023479985).

Keywords: Network meta-analysis; Nurse-led interventions; Patients; Smoking cessation intervention; Systematic review.