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可以通过改变个人健康行为来预防。初级保健医生为大多数美国人提供基本保健，他们提出的健康行为建议(HBA)有望成为改变癌症相关健康行为、降低发病率和死亡率的一项战略。一种潜在的有效策略是利用就诊作为健康行为改变的“可教时刻”(TM)。我们对音频记录的医患互动的深入分析导致了对TM通信元素的新发现。首先，有效的TM包括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。说服是通过暗示改变健康行为将改善患者的显著关切来完成的。如果做得巧妙，患者会接受健康行为的描述，认为这是一个相关的问题，并表现出对健康行为改变谈话的理解，可能表达了改变的承诺。我们的数据显示，在医患之间的健康行为讨论中，TMS出现在20%的情况下。然而，更常见的(43%)是TM‘尝试’失败的患者。这些尝试缺乏好的以患者为中心的建议的两个基本方面：1)引起患者对改变的准备；2)根据患者表达的改变阶段做出反应。我们还观察到“错失的机会”(20%)，其中健康行为建议未能与患者突出关注的问题联系起来。因此，这项随机试验的目标是测试一种干预措施，培训临床医生将TMS的使用与针对门诊环境中的吸烟和体重管理而量身定做的激励性访谈的关键技能相结合。这一目标将通过对32名临床医生(1920名患者)进行分组随机试验和交叉研究设计来实现。最初的简短可教瞬间技能(B组)干预将重点放在戒烟作为健康行为主题上。在交叉点，延迟干预组将接受B组干预，但重点是体重控制。B-Team涉及多种方式，包括基于技能的培训、与标准化患者的练习和现场指导。对吸烟或肥胖患者的访问录像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。患者调查将被用来评估观察到的健康行为改变策略对患者即时和短期结果的影响。利用临床医生自然发生的健康行为改变策略，通过促进更有效的沟通技能的发展，具有增强患者健康行为改变的巨大潜力。这项研究将测试这一策略，并生成关于其有效性以及医生在实践中如何为吸烟和体重控制量身定做的丰富数据。吸烟和体重控制是癌症和其他毁灭性慢性疾病的两个重要风险因素。公共卫生相关性：该项目将教授初级保健医生在谈论戒烟或控制体重时改善与患者的沟通的技能。这种方法旨在通过增加以患者为中心的倾听技能来增强医生自然擅长的东西，因此很可能是有效的。

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.