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Critique of Systematic Research ReviewTitle : Nursing Interventions in Smoking Cessation
Critique of systematic research review: Nursing Interventions in Smoking Cessation
Health care professionals advise people about stopping smoking during their routine practice. Various studies have been conducted on the effectiveness of the interventions provided by health care professionals to smokers about smoking cessation. A systematic review is a methodological review process addressing a specific research question ( on treatment, diagnosis, prognosis or etiology) using explicit methodology of collecting, selecting, and appraising studies and, whenever appropriate, synthesizing results quantitatively(Denyer & Tranfield, 2009).The systematic review under consideration studies the effectiveness of various nurse- delivered smoking interventions(VH & Stead, 2013).
Relevance of the nursing research problem addressed
Since diseases due to tobacco use are on the rise throughout the world, along with death and disability as a consequence of continued use of tobacco, the American Nurses Association opined that nurses had a tremendous potential to implement smoking cessation interventions effectively in their practice(ANA, 2012). Smoking is the world’s largest cause of preventable morbidity and mortality(Helming, Helming, Barrere, Avino, & Shields, 2013). The Tobacco Free Nurses has adopted a 5 A’s behavioral approach for behavior modification, which include elements like asking about smoking habits, advising tobacco users to quit, assessing the motivation and readiness to quit, assisting by provide counseling and arrange support, and arranging follow-up visits to encourage ongoing abstinence(Helming et al., 2013). Of all the health workers, nurses constitute the largest workforce and if smokers receive non-smoking advice from their nurse health care providers, they are more likely to quit smoking.
The Research Question
- Nurse delivered smoking interventions are more effective than no interventions at all(VH & Stead, 2013).
- Nurse delivered smoking interventions are more effective if the intervention is more intensive(VH & Stead, 2013).
- Nurse delivered interventions differ in effectiveness with health state and setting of the participants(VH & Stead, 2013)
- Nurse delivered smoking interventions are more effective if they include follow-ups(VH & Stead, 2013)
- Nurse delivered smoking interventions are more effective if they include aids that demonstrate the pathophysiological effects of smoking(VH & Stead, 2013).
Selection of studies : The studies selected for inclusion in this systematic review were those that had at least two intervention groups with random allocation of participation to the two groups and with a documented minimum period of 6 months of follow-up(VH & Stead, 2013). Historically controlled studies were excluded from the review(VH & Stead, 2013).
Population studied : The population studied included adult smokers above the age of 18 years of both genders, recruited from any type of setting, healthcare or otherwise. Study Interventions : The types of study interventions provided by nurses were pre-determined to be those where in nurses advised about smoking cessation, those where nurses provided counseling for smoking cessation and those that included strategies that would help people quit smoking.
Study Outcome : Smoking cessation was taken to be the primary and only outcome measure studied. Cessation of smoking was determined to be either sustained cessation or biochemical evidence of cessation. Those who were lost- to- follow- up were classified as continued smokers.
Critique the levels of evidence the studies used in the SRR
Critique of the clarity of the presentation of the studies and their critiques . All studies have been clearly critiqued based on their methods, participants, interventions, outcomes, and risks of biases like selection bias and attrition bias. The studies have been arranged in the order of their study IDs and in tabular form. The reviewers used pre-defined inclusion and exclusion criteria to select studies for the review. They used criteria of credibility of evidence like randomization( all studies included random allocation), extent of follow up, and intention to treat analysis for this review. They did not use studies that used blinding. Only interventional studies were used for this review.
Data abstraction : The reviewers read the results of the study and abstracted data independently. Disagreements were settled by referring to a third person.
Data synthesis: Dissimilarity of results were assessed using heterogeneity tests, using the I2 statistic.
Description of the overall findings of the studies summarized in the Systematic research review . Overall findings showed a modest but positive effect for smoking cessation intervention by nurses. Smokers who were offered advice by a nursing professional had an increased likelihood of quitting smoking when compared to smokers without intervention. The review did not show evidence of any difference between high intensity interventions and low intensity interventions in terms of treatment effects. To a certain extent the review showed there was a difference in effectiveness between participants in different states of health. The evidence was not strong that follow-ups produced more effective smoking cessation behaviors. The same effect was noticed if aids that demonstrated pathophysiological effects of smoking were used. In conclusion a structured smoking cessation intervention delivered by a nurse was more effective than usual care on smoking abstinence for 6 months or more from the start of treatment and this effect was seen if the intensities of treatment were high/low, in different settings and in smokers with or without tobacco-related illnesses. The results of the review were expressed as risk ratio with 95% confidence limits.
Critique of the conclusions of the Systematic Research Review . As the authors have mentioned, the findings of these meta-analyses need to be interpreted with caution because there are limitations of the review and the clinical trials selected for the review. The authors used only tabulated data from published works for this study and this might have introduced a publication bias. Though the reviewers used good research methods like searching electronic databases, abstracts of conferences or meetings, and hand searching, they might have extended their search to include discourses with experts and pharmaceutical companies. There is no mention of non-English language studies having been included in the review. Since the review is not comprehensive, the results of the review might only be called tentative(Prasad, 2004). In addition there may be a publication bias in that only studies which showed positive results might have been published(N.d, 2006).
The results of this review might be applied to any local population because as mentioned in the review, nurses are uniquely placed to deliver health advice and counseling to patients about smoking cessation. They are more likely to meet up with patients on follow- up visits too, where they can reinforce the smoking cessation advice. The review addressed only one primary outcome that is absolute smoking cessation. Using the same resources, the review might have addressed additional outcomes like awareness about smoking cessation, awareness and knowledge about advantages of smoking cessation and so on. This review shows us that future research on smoking cessation behavior change interventions should be carefully planned, with careful consideration of participant selection, sample sizes, refusals and dropouts of the study, long-term follow-up etc..,. Randomized controlled studies that carefully examine the effects of the intervention are required. Awareness about the proper conduct of research studies and especially those that involve interventions should be created in the research community to increase reliability and validity of the studies. The results of a meta-analyses might be more generalizable when compared to other studies, because they are based on the results of studies on a large variety of populations. To such end systematic reviews and meta-analyses provide the highest level of evidence for health care workers and policy makers.
References
ANA. (2012). Nursing interventions for smoking cessation ( Review ). Nursing World. Retrieved November 28, 2014, from http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse/TobaccoFree.html
Denyer, D., & Tranfield, D. (2009). Producing a Systematic Review. In The SAGE Handbook of Organizational Research Methods (pp. 671–689).
Helming, M., Helming, T. C. for D. and M. P. P. of N. Q. U. S. of N. H. C. M., Barrere, C. C., Avino, K., & Shields, D. (2013). Core Curriculum for Holistic Nursing (p. 400). Jones & Bartlett Publishers. Retrieved from http://books.google.com/books?id=A656Ve--pPYC&pgis=1
Prasad, K. (2004). Fundamentals of Evidence-based Medicine: Basic Concepts in Easy Language. Retrieved from http://books.google.com.qa/books/about/Fundamentals_of_Evidence_based_Medicine.html?id=B2E4QwAACAAJ&pgis=1
VH, R., & Stead, L. (2013). Nursing interventions for smoking cessation ( Review ). Cochrane Database of Systematic Reviews, (8).