A randomized trial to evaluate primary care clinician training to use the Teachable Moment Communication Process for smoking cessation counseling

PREVENTIVE MEDICINE

卷:69

Article

Flocke, Susan A.^1,2,3,4  Step, Mary M.^1,3,5  Antognoli, Elizabeth¹  Lawson, Peter J.¹  Smith, Samantha¹  Jackson, Brigid¹  Krejci, Sue¹  Parran, Theodore⁶  Marsh, Sybil¹ 

[1] Case Western Reserve Univ, Dept Family Med & Community Hlth, Cleveland, OH 44106 USA

[2] Case Western Reserve Univ, Dept Epidemiol & Biostat, Cleveland, OH 44106 USA

[3] Case Comprehens Canc Ctr, Cleveland, OH USA

[4] Case Western Reserve Univ, Prevent Res Ctr Healthy Neighborhoods, Cleveland, OH 44106 USA

[5] MetroHlth Med Ctr, Div Med, Cleveland, OH USA

[6] Case Western Reserve Univ, Dept Med, Cleveland, OH 44106 USA

关键词: Tobacco counseling;    Primary care;    Brief advice;    Cluster randomized trial;    Audio recordings;   

DOI  :  10.1016/j.ypmed.2014.10.020

来源: Elsevier

【 摘 要 】

Objective. To implement and evaluate the impact of a Teachable Moment Communication Process (TMCP) training intervention on clinicians' smoking cessation counseling behaviors in practice. Method. Using a group randomized trial, 31 community-based, primary care clinicians in Northeast Ohio received either TMCP training or an attention control (2010-2012). TMCP training consisted of two, three-hour sessions involving didactic instruction, skill practice with standardized patients, and coaching. Clinician performance of TMCP elements was assessed by coding audio-recordings of routine visits with smokers at baseline and post-intervention (n = 806). Results. Baseline performance of all TMCP elements was similar in the two groups. After the intervention, TMCP-trained clinicians were more often observed advising patients to quit while linking smoking to the patient's concern (58% vs. 44%, p = 0.01), expressing optimism (36% vs. 3%, p < 0.001), expressing partnership (40% vs. 12%, p = 0.003) and eliciting the patient's readiness to quit (84% vs. 65%, p = 0.006) than clinicians in the comparison group. TMCP-trained clinician responses were also better aligned with patients' expressed readiness to quit smoking than comparison group clinicians (p < 0.001). Conclusion. The intervention significantly changed the content of clinicians' smoking cessation communication in ways consistent with the TMCP model for health behavior change. (C) 2014 Elsevier Inc. All rights reserved.

【 授权许可】

Free