Enhancing Teachable Moment Communication for Smoking Cessation and Weight Management
Condition: Clinician Patient Communication; Smoking Cessation; Weight Management
MeSH terms: Body Weight
Study type: Interventional

Summary: 
      The goal of this study is to test an intervention that teaches clinicians to integrate the
      use of 'teachable moments' with the key skills of motivational interviewing tailored to
      address smoking and weight management in the primary care outpatient visit setting.
    

Detailed description: 
      A large burden of cancer morbidity and mortality is potentially preventable by changes in
      personal health behaviors. Health behavior advice (HBA) by primary care physicians, who
      provide basic health care to most Americans, holds great promise as a strategy to alter
      cancer-related health behaviors and to reduce morbidity and mortality. One potentially
      powerful strategy is the use of illness visits as a 'teachable moment'(TM) for health
      behavior change. Our in-depth analysis of audio recorded physician-patient interactions has
      led to new discoveries of the communication elements of a TM. First, effective TM's involve
      linking a health behavior to a salient patient problem and positioning the health behavior as
      a problem. Persuasion is accomplished by suggesting that changing the health behavior will
      improve the patient's salient concern. If done skillfully, the patient accepts the portrayal
      of the health behavior as a relevant problem and exhibits uptake of the health behavior
      change talk, possibly expressing a commitment to change. Our data reveal that TMs occur in
      20% of health behavior discussions between physician and patient. More frequent (43%) ,
      however, are TM 'attempts' which fail to engage the patient. These attempts lack two
      essential aspects of good patient-centered advice 1) eliciting the patient's readiness to
      change and 2) responding in alignment with the patient's expressed stage of change. We also
      observed 'missed opportunities' (20%) where the health behavior advice failed to link to a
      salient patient concern.

      Therefore, the goal of this randomized trial is to test an intervention that teaches
      clinicians to integrate the use of TMs with the key skills of motivational interviewing
      tailored to address smoking and weight management in the outpatient visit setting. This goal
      will be accomplished using a group randomized trial of 32 clinicians (1152 patients). The
      initial Teachable Moment Communication Process (TMCP) intervention will focus on smoking
      cessation as the health behavior topic. After the initial intervention is evaluated, the
      clinicians assigned to the control group will receive a revised TMCP intervention with a
      focus on weight management. The TMCP intervention involves multiple modalities including
      skills-based training, practice with standardized patients and on-site coaching. Audio
      recordings of visits with patients who smoke or are obese will be used to assess both
      intervention and control clinicians' health behavior change strategies at baseline and post
      intervention. Patient surveys will be used to assess the effect of the observed health
      behavior change strategies on immediate and short-term patient outcomes. Leveraging
      clinicians' naturally-occurring health behavior change strategies by fostering the
      development of more effective communication skills has great potential to enhance patient
      health behavior change. This study will test this strategy and generate rich data about its
      effectiveness and how it is tailored by physicians in practice for both smoking and weight
      management; two important risk factors for cancer and other devastating chronic diseases.
    

Intervention name(s): Teachable Moment Communication Process
Intervention type(s): Other
Intervention description(s): The Teachable Moment Communication Process intervention is designed to teach clinicians: (1) the skills necessary to recognize and foster teachable moments in clinical encounters, (2) strategies to effectively elicit the patients' perspective on health behavior change, and express their alignment with that perspective, and (3) the ability to respond to the patient in a non-confrontational manner while providing brief advice appropriate to the patient's expressed level of readiness to change. The Teachable Moment Communication Process intervention consists of two, 3-hour educational training sessions including didactic presentation, skill demonstration through video examples, skills practices with standardized patients, and feedback from peers and the trainers.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: clinician patient communication; smoking cessation; weight management; primary care; health behavior change advice