integrating smoking cessation treatment into online psychological care

• Research type

  Research Study

• Full title

  intEgrating Smoking Cessation treAtment into usual online Psychological care for people with common mEntal illness: an Online randomised feasibility and pilot study (ESCAPE-O)

• IRAS ID

  304857

• Contact name

  Gemma Taylor

• Contact email

  gmjm20@bath.ac.uk

• Sponsor organisation

  University of Bath

• ISRCTN Number

  ISRCTN10612149

• Duration of Study in the UK

  2 years, 11 months, 31 days

• Research summary

  Summary of Research:
  Smoking is the leading cause of preventable disease and death, in the UK and worldwide. Smoking prevalence has decreased from 29% during the 1990s to about 15%. However, smoking is twice as prevalent in people with common mental illness. There is growing evidence that smoking may worsen mental health. Our Cochrane review found that stopping smoking can improve mental health, an effect size equal to anti-depressant treatment. A Cochrane review of smoking cessation interventions for people with depression found that adding psychosocial mood management to usual smoking cessation treatment increased smoking cessation rates compared to usual smoking cessation treatment alone. Therefore, integrating smoking cessation support within treatment for mental illness could improve outcomes for people with mental illness who want to quit smoking. In England people with depression and anxiety can self-refer or be referred by their GP to IAPT. In IAPT patients receive cognitive behavioural therapy (CBT) delivered face-to-face, or via an online platform called SilverCloud.
  SilverCloud is used by more than 75% of NHS IAPT services, reaching over 450,000 patients with common mental illness since 2013. The programme is self-guided and supported by telephone contact from an IAPT therapist. Given that half of smokers are interested in using online smoking cessation support to quit smoking, and the potential reach of online interventions, a modest effect can offer significant health benefits and financial savings for the NHS. However, there are no internet interventions for smoking cessation that are tailored for people with common mental illness that are built to be delivered as part IAPT. Failing to provide online smoking cessation treatment in IAPT is a missed opportunity to help people quit smoking and improve their mental health. Such an intervention offers the most promising vehicle to reach a large number of people with common mental illness who have a high prevalence of smoking. Given the COVID-19 pandemic, the government has announced a new strategic focus on digital public health and the NHS is urgently looking for novel and remote ways to deliver services to their patients

  Summary of Findings:
  More people with depression and anxiety smoke compared to the general population. Stopping smoking can make people’s physical and mental health better. People can get help with their mental health or smoking online. Support for both at the same time is not available at the moment in health services. We ran a study to find out if it was possible to combine stop smoking with mental health support and get enough people to take part and answer questions online. This would help us understand if we could run a larger study to find out if combining support helps people to stop smoking.
  We invited adult smokers over the age of 18 who were getting online mental health support to take part. Those who agreed to take part had an equal chance of being put in a group that either had access to stop smoking support with their main treatment or received their main treatment alone. After 3 and 6 months, participants were sent questionnaires about their smoking, mental health, and views on the support and the study.
  1 in 5 people who were invited to take part agreed. In total, 309 people took part, which was below our target of 500. We found that 1 in 5 people who took part in the study reported trying to stop smoking, and this proportion was the same across both study groups. There were some technical problems with the online smoking support, which meant there was a delay in some people being able to access it. There was higher drop-out than we expected when we followed people up at 3 and 6 months; we only got responses from 1 in 3 participants.
  We have learnt a lot about the improvements we would need to run another study in future. This would include improving recruitment by targeting mental health services that have larger numbers of people getting online support and allowing a longer technical set-up time so the stop smoking support is available straightaway. We would also need to increase the number of people completing questionnaires at 3 and 6 months. The large number of participants who stopped taking part before the end makes it unclear whether we could test the combined support in a larger study.
  

• REC name

  Wales REC 6

• REC reference

  22/WA/0051

• Date of REC Opinion

  21 Feb 2022

• REC opinion

  Favourable Opinion