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

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 were 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.

Impact of Hospitalization for Acute Myocardial Infarction on Adherence to Statins Among Older Adults

“…(19) Several small studies show that clinicians can enhance the effect of the teachable moment by drawing clear connections between the health event and preventive health behaviors when counseling patients. (34,35) Thus, our study implies that clinicians can promote statin adherence after AMI by explicitly linking the prevention of recurrent cardiac events to medication adherence.…”

Is pregnancy a teachable moment for diet and physical activity behaviour change? An interpretative phenomenological analysis of the experiences of women during their first pregnancy

“…Empirically, the majority of research on significant life events as cues to action has focused on negative health experiences such as receiving a false‐positive screening result (Floyd, Steffens, Pavlik, & Andrykowski, ) and hospitalization (Wachsberg et al ., ) rather than positive life transitions, such as pregnancy, and in relation to unequivocally negative behaviours such as smoking (e.g., Flocke et al ., ). By contrast, pregnancy is often posited as having the potential to generate a TM.…”

Feasibility and pilot efficacy of a brief smoking cessation intervention delivered by vascular surgeons in the Vascular Physician Offer and Report (VAPOR) Trial

“…In several data syntheses compiled in Cochrane Database of Systematic Reviews 10,23-26 (Table III), delivering smoking cessation interventions at a time when the patient is most likely to "hear" smoking cessation advicedthe "teachable moment"dhas been attempted near the time of cardiac catheterization for coronary artery disease, treatment for lung cancer, and other types of health care interventions. 16,27,28 Smoking cessation interventions at this key time in a patient's health care have been shown to potentially improve smoking cessation rates by 40%. 10,28 The manner in which smoking cessation interventions are delivered may matter just as much as the timing, especially for patients facing invasive treatments.…”

“…16,27,28 Smoking cessation interventions at this key time in a patient's health care have been shown to potentially improve smoking cessation rates by 40%. 10,28 The manner in which smoking cessation interventions are delivered may matter just as much as the timing, especially for patients facing invasive treatments. In a study of primary care practices, delivering smoking cessation advice using a standardized empathetic, patient-centered approach increased patients' readiness to quit from 65% to 84%.…”