Effectiveness of computer-tailored Smoking Cessation Advice in Primary Care: a Randomised Trial (ESCAPE)

Lead Research Organisation: Medical Research Council

Abstract

Few smokers make use of smoking cessation services offered by the NHS, and as many as 70% of smokers do not intend to quit in the next year. Developing treatments to encourage more quit attempts, and to improve the success rate of quit attempts, is essential to reduce the numbers of people who smoke. Computer-based systems generating highly tailored behavioural feedback letters are a simple and inexpensive intervention that could be delivered to a large proportion of the smoking population. The aim of this research is to evaluate the effect of personally tailored feedback reports on quit rates and quitting activity, compared with standard self help.A random sample of cigarette smokers, aged between 18 and 65, identified from GP records from representative selections of practices from the GPRF will be recruited. Those consenting to take part will be randomly allocated to a control group to receive usual care and standard information or to an intervention group to receive usual care and standard information plus tailored feedback reports. Smoking status and cognitive change will be assessed by postal questionnaire at 6-months.

Technical Summary

Specialist smoking cessation clinics offering intensive face-to-face treatment offered by the NHS are attended by less than 2% of smokers, the majority preferring less intensive methods. As many as 70% of smokers have no serious intentions to attempt to quit in the next year. There is an urgent need to develop and deliver cost-effective interventions to the bulk of the population, rather than to the minority of dependent smokers who seek specialized help.

Computer-based systems offer a method for generating highly tailored behavioural feedback letters. With proactive mailing and recruitment, these can be cost-effectively produced on a large scale, combining the behavioural intervention principles used in clinical interventions with the participation rates of public health interventions.

This study aims to assess the effect on quit rates and quitting activity, of sending personally tailored feedback reports, based on an assessment of individual needs and tailored to levels of reading ability, to smokers identified from general practitioners lists with varying levels of motivation and readiness to quit, compared with sending standard self-help materials.

We will recruit 7250 participants over 12 months, through contact with smokers from representative selections of 100 practices from the GPRF to represent high and low socio-economic areas. A random selection of 500 cigarette smokers, between ages 18 and 65 from each practice (a total of 50000) will be sent an assessment questionnaire with a covering letter from their GP and those consenting to participate in the trial will be randomly allocated to an intervention group to receive usual care and standard information plus tailored feedback reports or a control group to receive usual care and to the standard non-tailored information. The intervention reports are generated from baseline data and are intended to encourage and help smokers to quit by changing the cognitive determinants of smoking and smoking cessation. Participants in the intervention group also get a follow-up assessment 1 month later and an additional tailored report. Outcomes will be assessed at 6 months and will include smoking status, cognitive change, adherence to advice, and perceptions of the feedback reports.

The study is funded by Cancer Research UK and is a collaboration between the GPRF and UCL.

Publications


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Wu Q (2014) Cost-effectiveness of computer-tailored smoking cessation advice in primary care: a randomized trial (ESCAPE). in Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco