Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands.
Patient Educ Couns. 2009 Jul;76(1):16-24. doi: 10.1016/j.pec.2008.11.017. Epub 2009 Jan 16.
Within the framework of a randomized, active treatment controlled trial, we used a mediation analysis to understand the mechanisms by which an intervention that uses confrontation with spirometry for smoking cessation achieves its effects.
Participants were 228 smokers from the general population with previously undetected chronic obstructive pulmonary disease (COPD), who were detected with airflow limitation by means of spirometry. They received two equally intensive behavioural treatments by a respiratory nurse combined with nortriptyline for smoking cessation: confrontational counselling with spirometry versus conventional health education and promotion (excluding confrontation with spirometry and COPD).
Cotinine validated abstinence rates from smoking at 5 weeks after the target quit date were 43.1% in the confrontational counselling group versus 31.3% in the control group (OR=1.67, 95%CI=0.97-2.87). The effect of confrontational counselling on abstinence was independently mediated by the expectation of getting a serious smoking related disease in the future (OR=1.76, 95%CI=1.03-3.00), self-exempting beliefs (OR=0.42, 95%CI=0.21-0.84), and self-efficacy (OR=1.38, 95%CI=1.11-1.73).
We conclude that confrontational counselling increases risk perceptions and self-efficacy, and decreases self-exempting beliefs (risk denial) in smokers with previously undetected COPD. These changes in mediators are associated with a higher likelihood of smoking cessation.
Apart from the intensity, the content of smoking cessation counselling may be an important factor of success. A confrontational counselling approach as we applied may have the potential to alter smoking-related cognitions in such a way that smokers are more successful in quitting. Nurses can be trained to deliver this treatment.
在一项随机、阳性药物对照试验的框架内，我们采用中介分析来了解一项使用肺量计来戒烟的干预措施产生效果的机制。
该研究纳入了 228 名来自普通人群且之前未被发现患有慢性阻塞性肺疾病（COPD）的吸烟者，这些人通过肺量计检测出气流受限。他们接受了由呼吸护士提供的两种同样强化的行为治疗，同时还给予了去甲替林戒烟：肺量计对抗咨询与常规健康教育和促进（不包括与肺量计和 COPD 的对抗）。
在目标戒烟日期后 5 周，使用可替宁验证的戒烟率在对抗咨询组为 43.1%，而在对照组为 31.3%（OR=1.67，95%CI=0.97-2.87）。肺量计对抗咨询对戒烟的影响通过以下因素独立中介：对未来患严重与吸烟相关疾病的预期（OR=1.76，95%CI=1.03-3.00）、自我豁免信念（OR=0.42，95%CI=0.21-0.84）和自我效能（OR=1.38，95%CI=1.11-1.73）。
我们的结论是，在之前未被发现患有 COPD 的吸烟者中，肺量计对抗咨询增加了风险感知和自我效能，并降低了自我豁免信念（风险否认）。这些中介因素的变化与戒烟的可能性增加有关。
除了强度之外，戒烟咨询的内容可能是成功的一个重要因素。我们应用的这种对抗咨询方法可能具有改变与吸烟相关的认知的潜力，使吸烟者更有可能成功戒烟。护士可以接受这种治疗方法的培训。
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