Summary of findings 1. Adjunctive counseling in addition to standard smoking cessation care in primary care.
| Adjunctive counseling in addition to standard smoking cessation care in primary care | ||||||
| Patient or population: people who attend primary care and smoke tobacco Setting: primary care (Australia, Europe, South Korea, United States) Intervention: adjunctive counseling plus standard or multicomponent smoking cessation support Comparison: standard or multicomponent smoking cessation support | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with control | Risk with adjunctive counseling | |||||
| Smoking abstinence at 6‐month follow‐up or more. All studies | Study population | RR 1.31 (1.10 to 1.55) | 18,150 (22 RCTs) | ⊕⊕⊕⊝ MODERATEa | ‐ | |
| 7 per 100 | 9 per 100 (8 to 11) | |||||
| Smoking abstinence at 6‐month follow‐up or more. Subgroup comparator: standard care | Study population | RR 1.43 (1.15 to 1.78) | 12,852 (17 RCTs) | ⊕⊕⊕⊝ MODERATEb | ‐ | |
| 4 per 100 | 6 per 100 (5 to 8) | |||||
| Smoking abstinence at 6‐month follow‐up or more. Subgroup comparator: multicomponent intervention | Study population | RR 1.04 (0.87 to 1.23) | 5298 (5 RCTs) | ⊕⊕⊝⊝ LOWc | ‐ | |
| 14 per 100 | 14 per 100 (12 to 17) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RCT: Randomized controlled trial; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
aDowngraded one level due to inconsistency. A subgroup analysis subgrouping by the nature of the comparator resulted in substantial subgroup differences (I2 = 80%). bDowngraded one level due to risk of bias. Removing the studies at high risk of bias shifted the confidence intervals so that they incorporated the potential for no benefit of adjunctive counseling. cDowngraded two levels due to imprecision. CI encompassed both potential benefit and harm.