Using a Teachable Moment Communication Process to Improve Outcomes of Quitline Referrals

NCT02764385 | Completed Results

• 1 other identifier: RES206807
• Study Type: interventional
• Target: 15,786
• Locations: 0 countries
• Sites: N/A

Brief Summary

This study will compare the effectiveness of two approaches for delivering smoking cessation advice in the primary care setting. Ask-Advise-Connect (AAC) is a strategy that uses the electronic health record (EHR) to prompt clinical staff to Ask if the patient smokes, Advise them to quit and, if they're interested, Connect them to Quitline (QL) counseling services. The connection occurs when a QL counselor is notified of the patient's interest, and then calls the patient to enroll in treatment. AAC has been shown to be very effective at enrolling patients, however, it was found that less than 42% of patients who agreed to be referred were successfully contacted by the QL after 5 call attempts. This indicates that many patients that are referred are not ready for cessation, but may feel obligated to accept the referral from their primary care team. This presents an opportunity to improve the patient centeredness of the referral process. To overcome these limitations, the investigators propose pairing it with a patient-centered smoking cessation approach called the Teachable Moments Communication Process (TMCP). The investigators' team developed this communication strategy, which incorporates patients' concerns into a partnership-oriented discussion about smoking cessation. The investigators propose that combining these two approaches could increase appropriate referrals to the QL, increase the likelihood of successful patient contact and enrollment, and increase the patient's rating of the value of the experience.

Conditions

Smoking; Tobacco Dependence

Outcome Measures

Primary Outcomes (1)

• Number of Patients Contacted for Quitline Enrollment

  The number of patients contacted by the Quitline among those ready to quit and who accepted a referral to the quitline

  Every visit until end of study, up to 6 months post TMCP implementation

Secondary Outcomes (1)

• Number of Patients With Documentation of Brief Advice

  Every visit until end of study, up to 6 months post TMCP implementation

Study Arms (2)

AAC only

OTHER

This is a system-based intervention that involves changes in the EHR regarding documenting tobacco assessment and the capability to order an eReferral to the Quitline. This system-based intervention also changes the role of the medical technical assistant.

Other: AAC

AAC + TMCP

OTHER

The Teachable Moment Communication Process is a clinician-focused intervention designed to guide an approach to discussing smoking cessation during routine primary care visits.

Other: Teachable Moment Communication Process; Other: AAC

Interventions

Teachable Moment Communication Process OTHER

A clinician-focused intervention designed to guide an approach to discussing smoking cessation during routine primary care visits.

AAC + TMCP

AAC OTHER

A system-based change to the EHR that allows for eReferral to the Quitline coupled with role and process changes for medical technical assistants

AAC + TMCP; AAC only

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• All adults age 18+ who present for visits at participating clinics

You may not qualify if:

• Any individual under 18 years of age presenting for a clinic visit

Sponsors & Collaborators

• Case Western Reserve University: lead
• Patient-Centered Outcomes Research Institute: collaborator

Related Publications (1)

• Flocke SA, Albert EL, Lewis SA, Love TE, Rose JC, Kaelber DC, Seeholzer EL. A cluster randomized trial evaluating a teachable moment communication process for tobacco cessation support. BMC Fam Pract. 2021 May 4;22(1):85. doi: 10.1186/s12875-021-01423-x.

  PMID: 33947346 DERIVED

MeSH Terms

Conditions

Smoking; Tobacco Use Disorder

Condition Hierarchy (Ancestors)

Behavior; Substance-Related Disorders; Chemically-Induced Disorders; Mental Disorders

Limitations and Caveats

Intent to treat analyses are presented. Of the 60 eligible clinicians, 44 had exposure to the Teachable Moment Communication Process training. Uptake and use of the communication process during patient visits was limited (less than 10% of eligible visits). This makes it difficult to evaluate the added value of the Teachable Moment Communication Process intervention over and above the Ask-Advise-Connect approach.

Results Point of Contact

• Title: Sue Flocke
• Organization: Oregon Health & Science University

flocke@ohsu.edu

5034946697

Study Officials

• Sue Flocke, PhD

  Oregon Health and Science University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: April 14, 2016
• First Posted: May 6, 2016
• Study Start: August 1, 2016
• Primary Completion: April 1, 2019
• Study Completion: April 1, 2019
• Last Updated: July 27, 2021
• Results First Posted: July 27, 2021

Record last verified: 2021-07

Data Sharing

• IPD Sharing: Will not share