Enhancing Teachable Moment Communication for Smoking Cessation and Weight Managem

加强戒烟和体重管理的教学瞬间沟通

基本信息

批准号：
8132991
负责人：
SUSAN A. FLOCKE
金额：
$ 58.76万
依托单位：
CASE WESTERN RESERVE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2004
资助国家：
美国
起止时间：
2004-09-01 至 2014-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8132991
关键词：
Address Adopted Adult American Behavior Behavioral Cancer Burden Chronic Disease Client satisfaction Communication Complement Counseling Cross-Over Studies Data Development Diet Diffusion Educational Intervention Educational process of instructing Effectiveness Elements Exercise Exhibits Fostering Goals Guidelines Health Health behavior Health behavior change Healthcare Intervention Knowledge Link Malignant Neoplasms Medical Education Medical History Modality Morbidity - disease rate Obesity Outcome Outpatients Overweight Patients Persuasive Communication Physicians Plant Roots Population Positioning Attribute Primary Care Physician Primary Health Care Readiness Research Research Design Resistance Risk Risk Factors Site Smoke Smoking Staging Surveys Techniques Testing Tobacco use Training Translating Video Recording Visit Weight base behavior change brief advice cigarette smoking computerized data processing design group intervention improved mortality motivational enhancement therapy patient oriented post intervention prevent primary care setting randomized trial skills skills training smoking cessation time use uptake

项目摘要

DESCRIPTION (provided by applicant): 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 trains 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 (1920 patients) and a crossover study design. The initial Brief Teachable Moment Skills (B- TEAMS) intervention will focus on smoking cessation as the health behavior topic. At the crossover point, the delayed intervention group will receive the B-TEAMS intervention but with a focus on weight management. B-TEAMS involves multiple modalities including skills-based training, practice with standardized patients and on-site coaching. Video 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. PUBLIC HEALTH RELEVANCE: This project will teach primary care physicians skills to improve their communication with patients when addressing talk about quitting smoking or managing weight. The approach is designed to enhance what physicians naturally do well by adding patient-centered listening skills, and thus is likely to be effective.

描述（由申请人提供）：个人健康行为的变化可以预防癌症发病率和死亡率的很大负担。为大多数美国人提供基本医疗保健的初级保健医生的健康行为建议（HBA），作为改变与癌症相关的健康行为并降低发病率和死亡率的一项策略。一种潜在的有力策略是将疾病探访用作“可教时刻”（TM）来改变健康行为。我们对有记录的医师与患者相互作用的深入分析导致了TM通信元素的新发现。首先，有效的TM涉及将健康行为与显着的患者问题联系起来，并将健康行为定位为问题。通过建议改变健康行为将改善患者的显着关注，从而实现说服力。如果熟练地完成，患者将健康行为的描绘视为一个相关问题，并表现出对健康行为改变谈话的吸收，可能表达了对改变的承诺。我们的数据表明，TMS发生在20％的医师和患者之间的健康行为讨论中。但是，更频繁（43％）是TM“尝试”，无法吸引患者。这些尝试缺乏良好以患者为中心的建议的两个基本方面1）引起患者准备改变的准备，2）与患者表达的变化阶段保持一致。我们还观察到“错过的机会”（20％），其中健康行为建议未能与显着的患者关注有关。因此，这项随机试验的目的是测试一项干预措施，该干预措施训练临床医生将使用TMS与量身定制的动机访谈的关键技能相结合，以在门诊就诊环境中针对吸烟和体重管理进行量身定制。该目标将使用32名临床医生（1920名患者）和跨界研究设计的小组随机试验来实现。最初的简短教学力矩技能（B-团队）干预将集中于戒烟作为健康行为主题。在跨界点，延迟的干预组将获得B-Teams干预，但重点是体重管理。 B团队涉及多种方式，包括基于技能的培训，对标准化患者的练习和现场教练。与吸烟或肥胖的患者访问的视频记录将用于评估干预和控制临床医生在基线和干预后的健康行为变化策略。患者调查将用于评估观察到的健康行为变化策略对即时和短期患者预后的影响。通过促进更有效的沟通能力的发展来利用临床医生的自然发生的健康行为改变策略，具有增强患者健康行为改变的巨大潜力。这项研究将测试该策略，并生成有关其有效性以及医生在实践中为吸烟和体重管理量身定制的丰富数据；癌症和其他毁灭性慢性疾病的两个重要危险因素。公共卫生相关性：该项目将教授初级保健医生的技能，以提高有关戒烟或管理体重的讨论时与患者的沟通。该方法旨在通过增加以患者为中心的听力技巧来增强医生自然做得很好的事情，因此很可能有效。