Enhancing the Evidence for Behavioral Counseling: A Perspective From the Society of Behavioral Medicine

Abstract

U.S. Preventive Services Task Force (USPSTF) clinical guidelines at present rarely assign the highest grade recommendation to behavioral counseling interventions for chronic disease prevention or risk reduction because of concerns about the certainty and quality of the evidence base. As a result, the broad integration of behavioral counseling interventions in primary care remains elusive. Thus, there is an urgent need for novel perspectives on how to generate the highest-quality and -certainty evidence for primary care-focused behavioral counseling interventions. As members of the Society of Behavioral Medicine (SBM)--a multidisciplinary scientific organization committed to improving population health through behavior change--we review the USPSTF mandate and current recommendations for behavioral counseling interventions and provide a perspective for the future that calls for concerted and coordinated efforts among SBM, USPSTF, and other organizations invested in the rapid and wider uptake of beneficial, feasible, and referable primary care-focused behavioral counseling interventions. This perspective highlights five areas for further development, including (1) behavioral counseling-focused practice-based research networks; (2) promotion of USPSTF evidence standards and the increased use of pragmatic RCT design; (3) quality control and improvement procedures for behavioral counseling training; (4) systematic research on effective primary care-based collaborative care models; and (5) methodologic innovations that capitalize on disruptive technologies and healthcare transformation. Collective efforts to improve the health of all Americans in the 21st century and beyond must ensure that effective, feasible, and referable behavioral counseling interventions are embedded in modern primary care practice.

Figure 1

Analytic framework for behavioral counseling interventions in clinical care Key questions: 1. Do changes in patients’ health behavior improve health or reduce risk factors? 2. What is the relationship between duration of health behavior change and health improvement (i.e., minimum duration, minimum level of change, and change–response relationship)? 3. What are the adverse effects of health behavior change? 4. Does health behavior change produce other positive outcomes (e.g., patient satisfaction, changes in other health care behaviors, improved function, and decreased use of health care resources)? 5. Is risk factor reduction or measured health improvement associated with reduced morbidity or mortality? 6. Is sustained health behavior change related directly to reduced morbidity or mortality? 7. Are behavioral counseling interventions in clinical care related directly to improved health or risk factor reduction? 8. Are behavioral counseling interventions in clinical care related directly to reduced morbidity or mortality? From Annals of Internal Medicine, Curry SJ, Grossman DC, Whitlock EP, Cantu A, Behavioral counseling research and evidence-based practice recommendations: U.S. Preventive Services Task Force perspectives, 160, 6, 407–13. Copyright © 2014 American College of Physicians. All Rights Reserved. Reprinted with the permission of American College of Physicians, Inc.