Tobacco Quitcenter, Lung Cancer Institute, Steeplechase Cancer Center, RWJ Barnabas Health, Robert Wood Johnson Barnabas Health University Hospital Somerset, Somerville, NJ.
Community Health and Wellness Unit, New Jersey Department of Health, State of New Jersey, Trenton, NJ.
Nicotine Tob Res. 2019 Nov 19;21(12):1580-1589. doi: 10.1093/ntr/nty162.
Clinical practice guidelines recommend comprehensive treatment for tobacco dependence including pharmacotherapies and behavioral interventions. Group counseling may deliver unique treatment aspects not available with other modalities. This manuscript provides a narrative review of group treatment outcomes from real-world practice settings and complements recent meta-analyses of randomized controlled trials (RCTs). Our primary goals were to determine whether group treatments delivered in these settings have yielded similar quit rates compared to individual treatment and to provide recommendations for best practices and policy.
Group treatment was defined as occurring in a clinical or workplace setting (ie, not provided as part of a research study), led by a professionally trained clinician, and offered weekly over several weeks. English language PubMed articles from January 2000 to July 2017 were searched to identify studies that included outcomes from both group and individual treatment offered in real-world settings. Additional data sources meeting our criteria were also included. Reports not using pharmacotherapy and research studies (eg, RCTs) were excluded. The primary outcome was short-term, carbon monoxide (CO)-validated point prevalence abstinence (4-week postquit date).
The review included data from 11 observational studies. In all cases, group treatment(s) had higher 4-week CO-validated quit rates (range: 35.5%-67.3%) than individual treatment(s) (range: 18.6%-53.3%).
Best practice group treatments for tobacco dependence are generalizable from research to clinical settings and likely to be at least as effective as intensive individual treatment. The added advantages of efficiency and cost-effectiveness can be significant. Group treatment is feasible in various settings with good results.
A major barrier to achieving high rates of tobacco abstinence is under-utilization of evidence-based treatment interventions. This review demonstrates the effectiveness and utility of group treatment for tobacco dependence. Based on the available data described in this narrative review in conjunction with existing RCT data, group treatment for tobacco dependence should be established and available in all behavioral health and medical settings. Group tobacco treatment is now one of the mandated reimbursable tobacco treatment formats within the US health care system, creating enormous opportunities for widespread clinical reach. Finally, comprehensive worksite group programs can further extend impact.
临床实践指南建议对烟草依赖进行全面治疗，包括药物治疗和行为干预。团体咨询可能提供其他方式无法提供的独特治疗方面。本文提供了对现实实践环境中团体治疗结果的叙述性综述，补充了最近对随机对照试验（RCT）的荟萃分析。我们的主要目标是确定这些环境中提供的团体治疗是否与个体治疗产生了类似的戒烟率，并为最佳实践和政策提供建议。
团体治疗被定义为在临床或工作场所环境中进行（即在研究中不提供），由专业培训的临床医生领导，并在数周内每周提供一次。从 2000 年 1 月至 2017 年 7 月，检索了英文 PubMed 文章，以确定在现实环境中提供团体和个体治疗的研究报告。还包括符合我们标准的其他数据来源。未使用药物治疗和研究报告（例如 RCT）的报告被排除在外。主要结局是短期、一氧化碳（CO）验证的点患病率戒断（戒烟日期后 4 周）。
综述包括 11 项观察性研究的数据。在所有情况下，团体治疗（s）的 4 周 CO 验证戒烟率（范围：35.5%-67.3%）均高于个体治疗（s）（范围：18.6%-53.3%）。
适用于烟草依赖的最佳实践团体治疗可以从研究推广到临床环境，并且可能至少与强化个体治疗一样有效。效率和成本效益的额外优势可能非常显著。团体治疗在各种环境中都可行，效果良好。
实现高烟草戒断率的主要障碍是证据基础治疗干预的利用不足。本综述证明了团体治疗对烟草依赖的有效性和实用性。基于本叙述性综述中描述的现有数据以及现有的 RCT 数据，应在所有行为健康和医疗环境中建立和提供用于烟草依赖的团体治疗。团体烟草治疗现在是美国医疗保健系统中强制性可报销的烟草治疗形式之一，为广泛的临床覆盖创造了巨大的机会。最后，全面的工作场所团体计划可以进一步扩大影响。
