Clinical trial NCT01575886: Enhancing Teachable Moment Communication for Smoking Cessation and Weight Management
Official title: Enhancing Teachable Moment Communication for Smoking Cessation and Weight
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Clinician Patient Communication
Smoking Cessation
Weight Management
Keywords: clinician patient communication
smoking cessation
weight management
primary care
health behavior change advice
Lead sponsor: Case Western Reserve University
Sponsor class: OTHER
First posted: 2012-04-12
Enrollment: 840
Sex: ALL
Minimum age (years): 18
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief 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.

Eligibility criteria: Inclusion Criteria:

* Patients visiting a clinician participating in the study on data collection days.
* For data collection Time 1 and 2, patients who report smoking at least 1 cigarette per day.
* For data collect times 3 and 4, patients who have a BMI \> 30 or patients who have a BMI \>25 and self-reporting any one of the following chronic conditions: high blood pressure, high cholesterol, heart disease or diabetes.

Exclusion Criteria:

* Inability to comprehend the invitation to participate in the study in English or Spanish
* No access to a telephone and no mailing address to complete follow up surveys.

Primary outcomes:
measure: performance of the elements of the teachable moment communication process
timeFrame: evaluated at time of observed/audio recorded visit; visits are evaluated between 2 weeks and 3 months after clinician exposure to the educational intervention
measure: incremental behavior change for smoking
timeFrame: 6 weeks
Secondary outcomes:
measure: duration of the visit
timeFrame: immediate
Other outcomes:
Locations:
city: Cleveland
country: United States
facility: Case Western Reserve University
state: Ohio
Study officials:
affiliation: Case Western Reserve University
name: Susan A Flocke, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Flocke SA, Antognoli E, Step MM, Marsh S, Parran T, Mason MJ. A Teachable Moment Communication Process for smoking cessation talk: description of a group randomized clinician-focused intervention. BMC Health Serv Res. 2012 May 3;12:109. doi: 10.1186/1472-6963-12-109.