Kristina Schnitzer1, Nicole Senft2, Hilary A Tindle3, Jennifer H K Kelley4, Anna E Notier5, Esa M Davis5, Nancy A Rigotti6, Antoine Douaihy5, Douglas E Levy7, Daniel E Singer8, Gina Kruse9. 1. Tobacco Research and Treatment Center, MA General Hospital, Boston, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA. Electronic address: kschnitzer@partners.org. 2. Vanderbilt University Medical Center, Nashville, USA. 3. Vanderbilt University Medical Center, Nashville, USA; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, USA. 4. Tobacco Research and Treatment Center, MA General Hospital, Boston, USA; Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, USA. 5. University of Pittsburgh, Pittsburgh, USA; University of Pittsburgh Medical Center, Pittsburgh, USA. 6. Tobacco Research and Treatment Center, MA General Hospital, Boston, USA; Harvard Medical School, Boston, USA; Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, USA; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA. 7. Tobacco Research and Treatment Center, MA General Hospital, Boston, USA; Harvard Medical School, Boston, USA; Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, USA. 8. Harvard Medical School, Boston, USA; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA. 9. Tobacco Research and Treatment Center, MA General Hospital, Boston, USA; Harvard Medical School, Boston, USA; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA.
Abstract
INTRODUCTION: Though telephone counseling is a modality commonly used to promote health behavior change, including tobacco cessation, specific counselor and participant behaviors that indicate engagement and therapeutic alliance remain poorly characterized in the literature. We sought to explore smokers' and counselors' engagement and rapport-building behaviors in telephone counseling for smoking cessation and patterns of these behaviors by smokers' psychiatric symptoms. METHODS: The study team transcribed, audio-recorded tobacco cessation counseling calls for the presence of engagement and rapport-building behaviors among recently hospitalized participants enrolled in a smoking cessation randomized controlled trial (RCT). The study used baseline data from the RCT to explore frequencies of counselors' and smokers' behaviors among smokers who had reported more (vs. fewer) symptoms of depression (PHQ8 ≥ 10) or anxiety (GAD7 ≥ 10) at study entry. RESULTS: Participants (n = 37) were mostly female (23/37), White (26/37), with a median age of 58. At study entry while hospitalized, moderate-to-severe symptoms of depression (18/37) and anxiety (22/37) were common. Participant-led engagement behaviors included referencing past quit attempts, asking questions, elaborating response to yes/no questions, expressing commitment to behavior change, and assigning importance to nonautomated calls. Counselor-led behaviors included building off prior interaction, empathy, normalizing challenges, reframing and summarizing, validating achievements, and expressing shared experience. Both participants and counselors engaged via general discussion and humor. Participant-led engagement behaviors appeared more often in call transcripts among patients with higher baseline depression and anxiety symptoms compared to those with lower symptom scores. CONCLUSIONS: This study classified participant-led, counselor-led, and shared engagement behaviors during tobacco cessation counseling calls. Increased engagement via telephone counseling may be important for individuals with psychiatric symptoms identified at the start of treatment.
INTRODUCTION: Though telephone counseling is a modality commonly used to promote health behavior change, including tobacco cessation, specific counselor and participant behaviors that indicate engagement and therapeutic alliance remain poorly characterized in the literature. We sought to explore smokers' and counselors' engagement and rapport-building behaviors in telephone counseling for smoking cessation and patterns of these behaviors by smokers' psychiatric symptoms. METHODS: The study team transcribed, audio-recorded tobacco cessation counseling calls for the presence of engagement and rapport-building behaviors among recently hospitalized participants enrolled in a smoking cessation randomized controlled trial (RCT). The study used baseline data from the RCT to explore frequencies of counselors' and smokers' behaviors among smokers who had reported more (vs. fewer) symptoms of depression (PHQ8 ≥ 10) or anxiety (GAD7 ≥ 10) at study entry. RESULTS: Participants (n = 37) were mostly female (23/37), White (26/37), with a median age of 58. At study entry while hospitalized, moderate-to-severe symptoms of depression (18/37) and anxiety (22/37) were common. Participant-led engagement behaviors included referencing past quit attempts, asking questions, elaborating response to yes/no questions, expressing commitment to behavior change, and assigning importance to nonautomated calls. Counselor-led behaviors included building off prior interaction, empathy, normalizing challenges, reframing and summarizing, validating achievements, and expressing shared experience. Both participants and counselors engaged via general discussion and humor. Participant-led engagement behaviors appeared more often in call transcripts among patients with higher baseline depression and anxiety symptoms compared to those with lower symptom scores. CONCLUSIONS: This study classified participant-led, counselor-led, and shared engagement behaviors during tobacco cessation counseling calls. Increased engagement via telephone counseling may be important for individuals with psychiatric symptoms identified at the start of treatment.
Authors: Andrea H Weinberger; Michael O Chaiton; Jiaqi Zhu; Melanie M Wall; Deborah S Hasin; Renee D Goodwin Journal: Am J Prev Med Date: 2020-03-07 Impact factor: 5.043