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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate professor Mattias Ekström, Karolinska Institutet, Sweden
- Second opponent: Researcher Gunhild Brørs, St. Olav's Hospital/Trondheim University Hospital, Norway
- Third member and chair of the evaluation committee: Associate Professor Kine Pedersen, University of Oslo
Chair of the Defence
Professor Kristine Kleivi Sahlberg, University of Oslo
Principal Supervisor
Professor John Munkhaugen, University of Oslo
Summary
Smoking is a major modifiable risk factor for recurrent events and premature mortality in patients with atherosclerotic cardiovascular disease (ASCVD). Hospitalisation represents a key opportunity for smoking cessation intervention. However, a substantial proportion of patients continue to smoke after discharge, and effective and scalable cessation strategies are needed.
The aims of this thesis were to assess the clinical effectiveness and cost-effectiveness of a smoking cessation intervention combining a nurse-led motivational interviewing session during hospitalisation with proactive referral to community-based follow-up.
The thesis is based on two open-label, blinded-endpoint randomised controlled trials and a health economic evaluation conducted at three Norwegian hospitals between 2021 and 2023. Adult patients with ASCVD who smoked daily prior to hospitalisation were randomised to either the intervention, consisting of a motivational interviewing session during hospitalisation and proactive referral to a municipal Healthy Life Centre, or to usual care with brief cessation advice and written information about the Healthy Life Centre programme and how to access it.
Smoking cessation rates were substantially higher in the intervention group. At six months, abstinence was 50% compared to 25% in the control group (OR 3.08, 95% CI 1.70–5.55). The intervention also increased participation in follow-up services and use of cessation pharmacotherapy.
The economic evaluation, conducted from a hospital perspective, showed lower hospital costs during 16 months of follow-up and increased survival, resulting in a high probability of cost-effectiveness when projected over a lifetime horizon.
In conclusion, a nurse-led motivational intervention initiated during hospitalisation and combined with proactive referral to follow-up in municipal Healthy Life Centres improves smoking cessation and is likely to be a cost-effective strategy in patients with ASCVD.
Additional information
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