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Table 2 Inclusion and exclusion criteria for Key Question 1c

From: Effectiveness of stop smoking interventions among adults: protocol for an overview of systematic reviews and an updated systematic review

“PICO” structured question element

Inclusion

Exclusion

Population

Adults (≥ 18 years) who are current tobacco smokers (as defined by a given study/review)

The overview of reviews will seek information on various population groups:

• Fewer versus more quit attempts

• Opportunistic versus individuals seeking treatment

• Baseline level of nicotine dependence (e.g. using a validated scale or cigarettes per day as a proxy)

• By demographic factors (age, SES, sex, ethnicity, LGBTQ+)

• By comorbid conditions (e.g. mental illness, HIV infection, cardiovascular disease, COPD, obesity, substance use disorder)

• By pregnancy status

▪ Reviews exclusively in children/adolescents (i.e. under 18 years old)

▪ Studies that involve interventions targeted to adults other than the tobacco smoker (e.g. partners, healthcare providers)

Intervention

Interventions to promote abrupt (i.e. “all at once”) or gradual (reducing smoking to quit) tobacco smoking cessation that can be directly delivered or referred to by primary care practitioners and are available in Canadaa

We will seek reviews which specifically examine the effectiveness of behavioural change techniques or cluster of techniques (e.g. explaining the consequences of smoking, strengthening ex-tobacco smoker identity, explaining the importance of abrupt cessation) which may be used as a component of the following behavioural change interventions:

• Practitioner advice (of varying length/intensity, and by various provider types)

o Very brief/minimal advice (as defined by a given review)

o Brief advice (as defined by a given review)

• Intensive individual counselling (of varying length, of varying number of sessions, and by various provider types)

• Intensive group counselling (of varying length, of varying number of sessions, and by various provider types)

• Self-help interventionsb (print-based or web/computer-based)

• Internet or computer-based interventions with counselling/supportb

• Telephone-based interventions (e.g. mobile phone-based, quit lines/help lines) with counselling/supportb

• Combinations of interventions

Behavioural change techniques delivered as part of other behavioural change interventions (i.e. other than those listed above) will be assessed on a case-by-case basis in consultation with the working group.

We will seek information on intervention characteristics which may moderate the effectiveness of behavioural change techniques (e.g. duration of intervention, number of sessions)

Reviews which intend to examine behavioural change interventions rather than behavioural change techniques.

Comparator

▪ No intervention

▪ Usual care

▪ Waitlist

▪ Minimal intervention

Behavioural change techniques or cluster of techniques delivered as part of:

▪ Other behavioural change intervention (e.g. head-to-head comparisons, comparisons of types or intensities of advice/counselling)

▪ Other combination of behavioural change interventions

▪ The same behavioural change intervention, but used to promote cessation by reducing smoking to quit as opposed to quitting abruptly or vice versa

 

Outcomes

Critical

• Tobacco use abstinence (as defined in a given review)

Important

• Reduction in tobacco smoking frequency/quantity

• Relapse (only when the comparator is an active intervention)c

• Quality of life (using validated scales)

• Adverse events (as defined in a given review)

• Possible adverse outcomes:

o Weight gain

o Changes in emotional state (e.g. increases in anxiety, changes in mood, irritability)

o Loss of social groupd

 

Timing of outcome assessment

For abstinence/relapse, and quality of life outcomes:

▪ Minimum 6 months from quit date (if reported) or from initiation of intervention (if quit date not specified)

All other outcomes:

Any point after initiation of intervention

 

Setting

Settings that could serve as the primary point of contact for individuals to receive smoking cessation advice, including:

• Family medicine clinics

• Walk-in clinics

• Smoking cessation clinics

• Urgent care facilities

• Emergency departments

• Public health units

• Pharmacies

• Dental offices

• Behavioural health/substance use treatment facilities (ambulatory or outpatient)

• Telehealth

• Academic research settings

Reviews in other settings (e.g. inpatient or specialist medical settings) will be assessed on a case-by-case basis in consultation with the working group

The effect of various settings may be examined

▪ Reviews in which > 50% of included studies took place in countries “high”, “medium”, or “low” on the Human Development Index http://hdr.undp.org/en/composite/HDI

Study design

Systematice reviews

Overviews6 of systematice reviews that include a network meta-analysis

• Primary studies

• Editorials

• Commentaries

Language

▪ English

▪ French

 

Dates of publications

2008 to present

 
  1. aIn this context, primary care practitioners refer to the provider of first contact for the delivery or referral to stop smoking interventions. This could include physicians, nurses, pharmacists, oral health professionals, counsellors, etc.
  2. bWe define “self-help interventions” to include “any manual or programme to be used by individuals to assist a quit attempt not aided by health professionals, counsellors or group support” as per the definition in Hartmann-Boyce et al. [55]. This differs from interventions that utilize computers, the web, or mobile phones to deliver interventions that involve counselling/support, although the platform of delivery may be the same
  3. cThe outcome “relapse” was initially considered critical based on WG rating. However, based on discussion with WG members, it was decided that this outcome should be considered important. It was also decided that this outcome is most important for head-to-head comparisons. We will only collect data for this outcome when the comparator is an active intervention such as behavioural change techniques or cluster of techniques delivered as part of a behavioural change intervention different from that offered to the intervention group (e.g. behavioural change technique or cluster of techniques delivered as part of practitioner advice versus intensive individual counselling)
  4. dAlthough initially rated as being of limited importance by the WG, based on discussions with WG members, it was decided that this outcome should be considered as important. Clinical experts and patients rated this outcome as important
  5. eReviews will be considered systematic if they meet the four following criteria: (1) searches at least one database, (2) reports their selection criteria, (3) conducts quality or risk of bias assessment on included studies, and (4) provides a list and synthesis of included studies
  6. 6Overviews will included if they meet the following criteria: (1) search at least one database, (2) report their selection criteria and how they will handle the inclusion of overlapping reviews, (3) provide information on the quality or risk of bias assessment of studies included in reviews, (4) provide a list of relevant reviews, (5) report the synthesized evidence from the included reviews, and (6) explicit declaration that the decision to undertake the network meta-analysis was made with firsthand knowledge of the primary studies, to ensure appropriateness of the analysis
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Systematic Reviews

ISSN: 2046-4053