Original Title: Interventions pour la cessation tabagique (y compris le vapotage)

Authors' objectives: Smoking, defined as the regular use of one or more tobacco- or nicotine-based products, leads to dependence. Currently, approximately 11% of the Québec population smokes conventional cigarettes, while 7% consume nicotine via electronic cigarettes. Numerous frontline healthcare professionals are involved in smoking cessation treatment, which relies on various support measures and pharmacotherapy. To assist and guide clinical practice, INESSS has developed a decision-support tool covering the entire clinical process for smoking cessation (including vaping cessation) by persons aged 12 and older.

Authors' results and conclusions: RESULTS (#1 A PERSONALIZED AND COMPASSIONATE APPROACH TO SUPPORT SHARED DECISION-MAKING): Engaging in empathetic, compassionate, and patient-centered dialogue is central to the clinical process of smoking cessation. While pharmacotherapy should always be offered in combination with one or more support measures to help achieve the person’s goals, it is important to personalize the treatment choice through shared decision-making. This approach considers clinical aspects as well as the person’s needs and preferences, past experiences, and psychosocial situation. (#2 A RANGE OF PROVEN PHARMACOTHERAPIES): Several pharmacotherapies are currently available to support the person engaged in a smoking cessation process. As first-line treatments, varenicline or combined nicotine replacement therapies (long- and short-acting) should generally be prioritized for the general population, although bupropion remains a valid option; cytisine, a natural product with a mechanism of action similar to varenicline, is also recommended as an alternative. Although scientific data mainly focus on conventional cigarettes, these pharmacotherapies may also be considered for persons who vape or consume other tobacco products. (#3 SUPPORTS MEASURES: A KEY COMPONENT TO PRIORITIZE): The consulted stakeholders emphasized the need to place greater importance on support and suitable preparation for persons attempting to quit tobacco or vaping products. Support measures are also widely recommended by clinical practice guidelines. These can take various forms, ranging from psychological education to psychotherapy, but should include a brief counselling session (of 30 seconds to 3 minutes) at the minimum. This session involves: 1) screening and identifying smokers and former smokers, regardless of the product used (e.g., electronic cigarettes, heated tobacco, smokeless tobacco, conventional cigarettes); 2) discussing smoking or vaping cessation, relapse risks, and available care and services; and 3) depending on their clinical relevance, offering support, follow-up, or educational and self-care materials.

Authors' recommendations: At the completion of this work and after carrying out an iterative process with the advisory committee, a triangulation method was used to consider and integrate the scientific data, literature-based information and recommendations, contextual elements, and stakeholder perspectives. A series of recommendations were then formulated, which are central to the project report and are summarized in the associated clinical tool.

Authors' methods: A literature review was conducted using scientific publications from bibliographic databases and other sources to identify: 1) documents presenting information and clinical recommendations on smoking cessation; and 2) primary research studies on the effectiveness and safety of cytisine and electronic cigarettes for smoking cessation. Québec-specific contextual information was also gathered, among government documents and data from clinical-administrative databases, to provide a portrait of the use of pharmacotherapies indicated for smoking cessation and reimbursed by the provincial public drug insurance plan. Stakeholder perspectives were collected from: 1) an advisory committee of healthcare professionals from various specialties and areas of expertise; 2) an oversight committee of representatives from professional organizations (orders, associations, and federations), decision-makers, and other interested parties (e.g., representatives from MSSS and INSPQ); and 3) consultation with users who had previously attempted to quit smoking. The clinical recommendations were developed based on a comprehensive assessment and integration of information and recommendations in the literature, stakeholder perspectives, and contextual elements specific to Québec. Finally, the overall quality, acceptability, and applicability of the work were evaluated by external expert reviewers active in the domain and future users not involved in earlier parts of the project.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/strategies-de-cessation-tabagique.html

Year Published: 2025

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Medicaments/Cessation_tabagique_vapotage_GN_INESSS.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)