title: 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.
  
  
  METHODS
  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 was 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).
  
  
  CONCLUSIONS
  The intervention significantly changed the content of clinicians' smoking cessation communication in ways consistent with the TMCP model for health behavior change.
authors.affiliation: Department of Family Medicine & Community Health, Case Western Reserve University, Cleveland, OH, USA; Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA; Case Comprehensive Cancer Center, Cleveland, OH, USA; Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH, USA. Electronic address: susan.flocke@case.edu.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Flocke
authors.affiliation: Department of Family Medicine & Community Health, Case Western Reserve University, Cleveland, OH, USA; Case Comprehensive Cancer Center, Cleveland, OH, USA; Division of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Step
authors.affiliation: Department of Family Medicine & Community Health, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Antognoli
authors.affiliation: Department of Family Medicine & Community Health, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Lawson
authors.affiliation: Department of Family Medicine & Community Health, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Smith
authors.affiliation: Department of Family Medicine & Community Health, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Brigid
authors.initials: B
authors.lastname: Jackson
authors.affiliation: Department of Family Medicine & Community Health, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Sue
authors.initials: S
authors.lastname: Krejci
authors.affiliation: Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Parran
authors.affiliation: Department of Family Medicine & Community Health, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Sybil
authors.initials: S
authors.lastname: Marsh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003376:Counseling / Q000379:methods; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D058015:Health Communication; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010817:Physician-Patient Relations; D010820:Physicians; D011320:Primary Health Care; D012907:Smoking / Q000523:psychology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D055815:Young Adult
keywords: Audio recordings; Brief advice; Cluster randomized trial; Primary care; Tobacco counseling