Values and preferences of patients with severe mental illness with regard to smoking cessation: results from a systematic review

Kristien Coteur, Laura Tops, Geertruida Bekkering, Linan Zeng, Bert Aertgeerts, Nicolas Delvaux, Thomas Agoritsas, Mieke Vermandere

Keywords: smoking cessation, primary care, mental health, patient-centered care, systematic review

Background:

Smoking rates among people with severe mental illness (SMI) are twice to thrice as high as in the general population, with more heavy smokers. Tobacco-related conditions, such as cardiovascular and respiratory disease, are also the leading cause of mortality in this patient group. Smoking cessation is thus a key component in protecting their physical health and reducing mortality rates. Regardless of motivation, quit rates in this vulnerable population are lower than in general population. More effort may be needed to obtain long-term sustainability of intervention effects. As there are currently no guidelines on smoking cessation among people with SMI, we aim to inform the development of such guidelines by researching patients’ preferences.

Research questions:

What are the values and preferences for smoking cessation interventions among adult patients with SMI?

Method:

A systematic literature review. We searched MEDLINE via Pubmed, Embase, Web of Science, CINAHL and Scopus. The sample included adult (18 years or older), current or past smokers with SMI. SMI was defined as presenting a diagnosis of schizophrenia, bipolar or mood disorder, including major depressive disorder, or post-traumatic stress disorder. Peer-reviewed publications of any research design that discussed values and preferences concerning smoking cessation interventions were included. Double-blind procedures are used for screening and data extraction. Quantitative data is analysed descriptively. Qualitative data is synthesised with the Best Fit Framework method.

Results:

From 11,853 articles, 59 studies were included. Most (n=28) were qualitative studies, quantitatively descriptive studies (n=18), or mixed-method studies (n=8). Preliminary, it seems that social factors and proactive engagement by professionals are important. We will present the final results at the meeting in May.

Conclusions:

This review is the first study to map values and preferences of patients with SMI concerning smoking cessation interventions. Its results will inform practitioners to efficiently implement evidence-based interventions for smoking cessation in a population with SMI.

Points for discussion:

Which misconceptions live among health care professionals about patients' willingness and ability to stop smoking?

How to address the gap in quality of health care for people with (severe) mental illness?

How can we improve the integration of physical and mental health care in primary care?

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