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

Susan A Flocke¹, Mary M Step², Elizabeth Antognoli³

¹Department 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.

Preventive Medicine

|December 3, 2014

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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