A cluster randomized trial evaluating a teachable moment communication process for tobacco cessation support

Area of Science:

• Health Services Research
• Behavioral Science
• Clinical Practice

Background:

• Primary care settings offer a vital opportunity for tobacco cessation interventions.
• The Ask-Advise-Connect (AAC) approach is a systems-based strategy for delivering tobacco cessation support.
• The teachable moment communication process (TMCP) is a clinician-focused counseling method designed to facilitate behavior change discussions.

Purpose of the Study:

• To evaluate the added value of TMCP training within a health system implementing an AAC approach.
• To assess the impact of TMCP on patient receipt of tobacco cessation support.
• To examine the uptake and utilization of the TMCP by clinicians.

Main Methods:

• A stepped wedge cluster randomized trial was conducted across eight community health centers.
• Clinician training included web-based modules and in-person skill development with standardized patients and coaching.
• Key outcomes measured patient contact and enrollment in cessation services, medication prescriptions, and quit attempts.

Main Results:

• Despite 68% of trained clinicians using TMCP at least once, overall utilization was low (8% of smoker visits).
• No significant improvement in overall tobacco cessation assistance outcomes was observed between AAC+TMCP and AAC-only periods.
• Visits where TMCP was used showed increased ordering of cessation medications (OR=2.6) and advice to quit (OR=3.2).

Conclusions:

• High fidelity to TMCP training did not translate to widespread adoption in routine practice.
• The limited uptake of TMCP hindered the evaluation of its impact on patient outcomes.
• Additional implementation strategies are necessary to support the sustainable adoption of TMCP in primary care settings.