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Randomized Controlled Trial
. 2014 Dec:69:267-73.
doi: 10.1016/j.ypmed.2014.10.020. Epub 2014 Oct 30.

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

Susan A Flocke  1 , Mary M Step  2 , Elizabeth Antognoli  3 , Peter J Lawson  3 , Samantha Smith  3 , Brigid Jackson  3 , Sue Krejci  3 , Theodore Parran  4 , Sybil Marsh  3
Affiliations
Randomized Controlled Trial

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

Susan A Flocke et al. Prev Med. 2014 Dec.

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 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.

Keywords: Audio recordings; Brief advice; Cluster randomized trial; Primary care; Tobacco counseling.

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Conflict of interest statement

Conflict of interest statement

The authors report no current or prior conflicts of interest. No financial disclosures were reported by the authors of this paper.

Figures

Figure 1
Figure 1
Clinician enrollment, randomization in 2010, and follow-up CONSORT flow diagram. Data collection with clinicians and patients in Northeast Ohio.
Figure 2
Figure 2
Schematic of the Teachable Moment Communication Process. Note: Figure reproduced with permission (BioMed Central Open Access license); originally published by BioMed Central in Flocke et al. BMC Health Services Research 2012, 12:109.
See this image and copyright information in PMC

References

    1. Association of American Medical Colleges. Physician Behavior and Practice Patterns Related to Smoking Cessation, Workforce. Washington DC: 2007.
    1. Butler CC, Rollnick S, Cohen D, Bachmann M, Russell I, Stott N. Motivational consulting versus brief advice for smokers in general practice: a randomized trial. Br J Gen Pract. 1999;49:611–616.
    1. Carroll JK, Antognoli E, Flocke SA. Evaluation of physical activity counseling in primary care using direct observation of the 5As. Ann Fam Med. 2011;9:416–22. - PMC - PubMed
    1. Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults — United States, 2011. MMWR. 2012a;61:889–907. - PubMed
    1. Centers for Disease Control and Prevention. National Health Interview Survey, 2011 Data Release [WWW Document] 2012b URL ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Datasets/NHIS/2011/samadult... (accessed 11.5.12)

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