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Hospital Based Populations: Overview of Evidence

​​​​Hospital Based Populations   Overview of Evidence 

The following recommendations, and supporting evidence, have been extracted from existing clinical practice guidelines to inform the development of the CAN-ADAPTT Summary Statements. 

CAN-ADAPTT worked with the Guidelines Advisory Committee (GAC) to conduct a literature search (years: 2002-2009) to identify existing clinical practice guidelines (CPGs). Five existing clinical practice guidelines were identified as meeting the high quality criteria set out in the AGREE Instrument. The recommendations contained in these high-quality CPGs have been used as the evidence base for the CAN-ADAPTT guideline development process. Click here to view CAN-ADAPTT’s guideline development process flowchart.

U.S. Department of Health and Human Services Public Health Service (2008)1


The interventions found to be effective in this Guideline have been shown to be effective in a variety of populations. In addition, many of the studies supporting these interventions comprised diverse samples of tobacco users. Therefore, interventions identified as effective in this Guideline are recommended for all individuals who use tobacco, except when medication use is contraindicated or with specific populations in which medication has not been shown to be effective (pregnant women, smokeless tobacco users, light smokers, and adolescents). (Strength of Evidence = B)

Registered Nurses Association of Ontario (2007)2
Nurses implement smoking cessation interventions, paying particular attention to gender, ethnicity and age-related issues, and tailor strategies to the diverse needs of the populations. (Strength of Evidence = C)
Organizations and Regional Health Authorities should consider smoking cessation as integral to nursing practice, and thereby integrate a variety of professional development opportunities to support nurses in effectively developing skills in smoking cessation intervention and counselling.
All corporate hospital orientation programs should include training to use brief smoking cessation interventions as well as information on pharmacotherapy to support hospitalized persons who smoke.  (Strength of Evidence = B)
New Zealand Ministry of Health (2007)3


Provide brief advice to stop smoking to all hospitalized people who smoke.  (Grade = A)  Arrange multi-session intensive support, medication and follow up for at least 1 month for all hospitalized patients who smoke.  (Grade = A) 
Briefly advise people awaiting surgery who smoke to stop smoking and arrange support (such as NRT) prior to surgery.  (Grade = A) 
All hospitals should have systems set up for helping patients to stop smoking.  This includes routinely providing advice to stop smoking and either providing a dedicated smoking cessation service within the hospital or arranging for smoking cessation treatment to be provided by an external service. (Grade = B) 
Advise parents and family members of hospitalized children to stop smoking and offer support to help them.  (Grade = √)
NRT can be provided to people with cardiovascular disease. However, where people have suffered a serious cardiovascular event (for example, people who have had a myocardial infarction or stroke) in the past 2 weeks or have a poorly controlled disease, treatment should be discussed with a physician.  In these cases, oral NRT products rather than patches are recommended as the preferred option. (Grade = B)

1. U.S. Department of Health and Human Services Public Health Service. (2008, May). Clinical practice guideline: Treating tobacco use and dependence: 2008 update.
2. Registered Nurses Association of Ontario (RNAO). (2007, March). Integrating smoking cessation into daily nursing practice. Retrieved October 26, 2007 from:​
3. Ministry of Health. (2007, August). New Zealand smoking cessation guidelines. Wellington: Ministry of Health.

    Hospita​l Based Populations