Susan A Flocke1, Mary M Step2, Elizabeth Antognoli3, Peter J Lawson3, Samantha Smith3, Brigid Jackson3, Sue Krejci3, Theodore Parran4, Sybil Marsh3. 1. Department of Family Medicine & Community Health, Case Western Reserve University, Cleveland, OH, USA; Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA; Case Comprehensive Cancer Center, Cleveland, OH, USA; Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH, USA. Electronic address: susan.flocke@case.edu. 2. Department of Family Medicine & Community Health, Case Western Reserve University, Cleveland, OH, USA; Case Comprehensive Cancer Center, Cleveland, OH, USA; Division of Medicine, MetroHealth Medical Center, Cleveland, OH, USA. 3. Department of Family Medicine & Community Health, Case Western Reserve University, Cleveland, OH, USA. 4. Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Abstract
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 eitherTMCP 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.
RCT Entities:
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.
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