Lai Douglas Tc, Cahill Kate, Qin Ying, Tang Jin-Ling
Professional Development and Quality Assurance, Department of Health, 1/F Main Block, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Rd, Chai Wan, Hong Kong.
Cochrane Database Syst Rev. 2010 Jan 20(1):CD006936. doi: 10.1002/14651858.CD006936.pub2.
Motivational Interviewing (MI) is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help smokers to a make a successful attempt to quit.
To determine the effects of motivational interviewing in promoting smoking cessation.
We searched the Cochrane Tobacco Addiction Group Specialized Register for studies with terms (motivational OR motivation OR motivating OR motivate OR behavi* OR motivat*) and (interview* OR session* OR counsel* OR practi*) in the title or abstract, or as keywords. Date of the most recent search: April 2009.
Randomized controlled trials in which motivational interviewing or its variants were offered to smokers to assist smoking cessation.
We extracted data in duplicate. The main outcome measure was abstinence from smoking after at least six months follow up. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow up were treated as continuing smokers. We performed meta-analysis using a fixed-effect Mantel-Haenszel model.
We identified 14 studies published between 1997 and 2008, involving over 10,000 smokers. Trials were conducted in one to four sessions, with the duration of each session ranging from 15 to 45 minutes. All but two of the trials used supportive telephone contacts, and supplemented the counselling with self-help materials. MI was generally compared with brief advice or usual care in the trials. Interventions were delivered by primary care physicians, hospital clinicians, nurses or counsellors. Our meta-analysis of MI versus brief advice or usual care yielded a modest but significant increase in quitting (RR 1.27; 95% CI 1.14 to 1.42). Subgroup analyses suggested that MI was effective when delivered by primary care physicians (RR 3.49; 95% CI 1.53 to 7.94) and by counsellors (RR 1.27; 95% CI 1.12 to 1.43), and when it was conducted in longer sessions (more than 20 minutes per session) (RR 1.31; 95% CI 1.16 to 1.49). Multiple session treatments may be slightly more effective than single sessions, but both regimens produced positive outcomes. Evidence is unclear at present on the optimal number of follow-up calls.There was variation across the trials in treatment fidelity. All trials used some variant of motivational interviewing.Critical details in how it was modified for the particular study population, the training of therapists and the content of the counselling were sometimes lacking from trial reports.
AUTHORS' CONCLUSIONS: Motivational interviewing may assist smokers to quit. However, the results should be interpreted with caution due to variations in study quality, treatment fidelity and the possibility of publication or selective reporting bias.
动机性访谈（MI）是一种以患者为中心的指导性咨询方式，旨在帮助人们探索并解决行为改变方面的矛盾心理。它最初是作为一种治疗酒精滥用的方法而开发的，但可能有助于吸烟者成功尝试戒烟。
确定动机性访谈在促进戒烟方面的效果。
我们在Cochrane烟草成瘾小组专业注册库中进行检索，查找标题或摘要中包含（动机性或动机或激励或激励或行为或动机）以及（访谈或会话或咨询或实践）作为关键词的研究。最近一次检索日期为2009年4月。
将动机性访谈或其变体提供给吸烟者以协助戒烟的随机对照试验。
我们进行了重复数据提取。主要结局指标是至少随访六个月后的戒烟情况。我们采用了每个试验中最严格的戒烟定义，并在可行的情况下采用生化验证的戒烟率。失访的受试者被视为继续吸烟者。我们使用固定效应Mantel-Haenszel模型进行荟萃分析。
我们确定了1997年至2008年间发表的14项研究，涉及超过10,000名吸烟者。试验进行了1至4次会话，每次会话持续时间为15至45分钟。除两项试验外，所有试验均使用支持性电话联系，并辅以自助材料。在试验中，MI通常与简短建议或常规护理进行比较。干预由初级保健医生、医院临床医生、护士或咨询师提供。我们对MI与简短建议或常规护理的荟萃分析显示，戒烟率有适度但显著的提高（RR 1.27；95% CI为1.14至1.42）。亚组分析表明，由初级保健医生提供MI时有效（RR 3.49；95% CI为1.53至7.94），由咨询师提供时也有效（RR 1.27；95% CI为1.12至1.43），并且当会话时间较长（每次会话超过20分钟）时也有效（RR 1.31；95% CI为1.16至1.49）。多次会话治疗可能比单次会话略有效，但两种方案都产生了积极的结果。目前关于最佳随访电话次数的证据尚不清楚。各试验在治疗依从性方面存在差异。所有试验均使用了动机性访谈的某种变体。试验报告有时缺乏针对特定研究人群对其进行修改的关键细节、治疗师的培训以及咨询的内容。
动机性访谈可能有助于吸烟者戒烟。然而，由于研究质量、治疗依从性的差异以及发表或选择性报告偏倚的可能性，结果应谨慎解释。
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