1 School of Public Health, The University of Queensland, Herston, QLD, Australia.
2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.
Aust N Z J Psychiatry. 2017 Nov;51(11):1106-1120. doi: 10.1177/0004867417726176. Epub 2017 Aug 31.
To review the quality of current smoking cessation guidelines that include recommendations for people with severe mental illness.
A systematic search of scientific databases, central government health authority websites, psychiatry peak bodies, guideline clearing houses and Google was undertaken for relevant smoking cessation guidelines. Three reviewers independently assessed guideline quality using the AGREE II (Appraisal of Guidelines for REsearch and Evaluation II) instrument. Two reviewers extracted recommendations specific to smokers with severe mental illness.
Thirteen guidelines met the inclusion criteria. Seven guidelines scored ⩾60% in at least four domains. Median scores for 'Editorial independence', 'Rigour of development', 'Stakeholder Involvement' and 'Applicability' were less than 60%. The highest median scores were for 'Scope and purpose' (87%, 69-96%) and 'Clarity of presentation' (87%, 56-98%). 'Editorial independence' (33.3%, 0-86%) and 'Rigour of development' (54%, 11-92%) had the lowest median domain scores. The guidelines varied greatly in their recommendations but the majority recommended nicotine replacement therapy, bupropion or varenicline as first-line pharmacotherapy, along with behavioural support.
Many guidelines did not adequately report their methods or the competing interests of the authors. Future guidelines development may benefit from more specifically addressing AGREE II criteria and the needs of smokers with severe mental illness.
综述纳入严重精神疾病患者推荐意见的戒烟指南的质量。
系统检索科学数据库、中央政府卫生部门网站、精神病学权威机构、指南制定机构和谷歌，以获取相关戒烟指南。三位评审员使用 AGREE II（评估研究和评估指南 II）工具独立评估指南质量。两位评审员提取了针对严重精神疾病吸烟者的具体建议。
符合纳入标准的指南有 13 条。有 7 条指南在至少 4 个领域的得分 ⩾60%。“编辑独立性”、“制定严谨性”、“利益相关者参与”和“适用性”的中位数评分均低于 60%。“范围和目的”（87%，69-96%）和“表述清晰度”（87%，56-98%）的中位数评分最高。“编辑独立性”（33.3%，0-86%）和“制定严谨性”（54%，11-92%）的中位数评分最低。这些指南在推荐意见上差异很大，但大多数建议将尼古丁替代疗法、安非他酮或伐尼克兰作为一线药物治疗，并辅以行为支持。
许多指南没有充分报告其方法或作者的利益冲突。未来的指南制定可能会从更具体地解决 AGREE II 标准和严重精神疾病吸烟者的需求中受益。
