Enhancing Teachable Moment Communication for Smoking Cessation and Weight Managem

描述（由申请人提供）：癌症发病率和死亡率的巨大负担可能通过个人健康行为的改变来预防。健康行为建议（HBA）的初级保健医生，谁提供基本的卫生保健，大多数美国人，持有很大的希望作为一种战略，以改变癌症相关的健康行为，降低发病率和死亡率。一个潜在的强有力的策略是使用疾病访问作为健康行为改变的“可教时刻”（TM）。我们对医生与病人互动录音的深入分析导致了TM沟通元素的新发现。首先，有效的TM涉及将健康行为与突出的患者问题联系起来，并将健康行为定位为问题。说服是通过建议改变健康行为将改善患者的突出问题来实现的。如果做得巧妙，病人接受健康行为的描述作为一个相关的问题，并表现出吸收健康行为改变谈话，可能表达了改变的承诺。我们的数据显示，TM发生在20%的医生和病人之间的健康行为讨论。然而，更常见的（43%）是TM“尝试”，未能吸引患者。这些尝试缺乏良好的以病人为中心的建议的两个基本方面：1）引起病人的准备改变和2）响应与病人的表达阶段的变化。我们还观察到“错失机会”（20%），其中健康行为建议未能与突出的患者问题联系起来。因此，这项随机试验的目的是测试一种干预措施，培训临床医生将TM的使用与针对门诊就诊环境中吸烟和体重管理的动机访谈的关键技能相结合。这一目标将通过32名临床医生（1920例患者）的分组随机试验和交叉研究设计来实现。最初的简短可教时刻技能（B- TEAMS）干预将侧重于戒烟作为健康行为主题。在交叉点，延迟干预组将接受B-TEAMS干预，但重点是体重管理。B-TEAMS涉及多种模式，包括基于技能的培训，标准化患者的实践和现场辅导。吸烟或肥胖患者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改变策略。患者调查将用于评估观察到的健康行为改变策略对即刻和短期患者结局的影响。通过培养更有效的沟通技能来利用临床医生自然发生的健康行为改变策略，对增强患者健康行为改变具有很大的潜力。这项研究将测试这一策略，并生成有关其有效性的丰富数据，以及医生如何在实践中为吸烟和体重管理量身定制;这是癌症和其他毁灭性慢性疾病的两个重要风险因素。

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.