Evidence map›Paper›PMID 33947346›Full record

Trial reportBMC family practice2021

A cluster randomized trial evaluating a teachable moment communication process for tobacco cessation support.

Susan A Flocke, Elizabeth L Albert, Steven A Lewis, Thomas E Love, Jeanmarie C Rose, David C Kaelber, Eileen L Seeholzer

Registry-linked trialOpen access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC family practice, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02764385 (Using a Teachable Moment Communication Process to Improve Outcomes of Quitline Referrals), which is not on this map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
4.4field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02764385 nacompletednot on this map

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

TypeinterventionalSponsorCase Western Reserve UniversityRan2016 to 2019Enrolled15,786ConditionsSmoking, Tobacco DependenceArmsTeachable Moment Communication Process, AAC
3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 1 country.

Susan A FlockeDepartment of Family Medicine, Oregon Health & Science, University, 3800 SW Sam Jackson Park Rd, Portland, OR, 97239, USA. flocke@ohsu.edu.
Elizabeth L AlbertCenter for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA.
Steven A LewisPopulation Health Research Institute, MetroHealth System, OH, Cleveland, USA.
Thomas E LovePopulation Health Research Institute, MetroHealth System, OH, Cleveland, USA.
Jeanmarie C RoseCenter for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA.
David C KaelberPopulation Health Research Institute, MetroHealth System, OH, Cleveland, USA.
Eileen L SeeholzerPopulation Health Research Institute, MetroHealth System, OH, Cleveland, USA.
Case Western Reserve University · USMetroHealth · USOregon Health & Science University · US

Funding

Clinical and Translational Science Collaborative of ClevelandUL1TR002548 · NCATS · CASE WESTERN RESERVE UNIVERSITY · PI MCCOMSEY, GRACE A · 2018 to 2022
$35.5M
NCATS NIH HHS UL1 TR002548
6 · The paper itself

Abstract

introductionThis study examines the uptake of a clinician-focused teachable moment communication process (TMCP) and its impact on patient receipt of tobacco cessation support. The TMCP is a counseling method that uses patient concerns to help clinicians guide behavior change discussions about tobacco. We evaluate the added value of the TMCP training in a health system that implemented an Ask-Advise-Connect (AAC) systems-based approach.

methodsA stepped wedge cluster randomized trial included eight community health centers. Training involved a web module and onsite skill development with standardized patients and coaching. Main outcome measures included contact and enrollment in cessation services among patients referred for counseling, prescription of cessation medications and quit attempts.

resultsForty-four of 60 eligible clinicians received the TMCP training. Among TMCP-trained clinicians 68% used a TMCP approach (documented by flowsheet use) one or more times, with the median number of uses being 15 (IQR 2-33). Overall, the TMCP was used in 661 out of 8198 visits by smokers (8%). There was no improvement in any of the tobacco cessation assistance outcomes for the AAC + TMCP vs. the AAC only period. Visits where clinicians used the TMCP approach were associated with increased ordering of tobacco cessation medications, (OR = 2.6; 95% CI = 1.9, 3.5) and providing advice to quit OR 3.2 (95% CI 2.2, 4.7).

conclusionsDespite high fidelity to the training, uptake of the TMCP approach in routine practice was poor, making it difficult to evaluate the impact on patient outcomes. When the TMCP approach was used, ordering tobacco cessation medications increased. IMPLICATIONS: Tobacco cessation strategies in primary care have the potential to reach a large portion of the population and deliver advice tailored to the patient. The poor uptake of the approach despite high training fidelity suggests that additional implementation support strategies, are needed to increase sustainable adoption of the TMCP approach.

trial registrationclinicaltrials.gov #NCT02764385 , registration date 06/05/2016.

Indexed as

Smoking CessationTobacco Use CessationCommunicationCounselingHumansPrimary Health Care

Identifiers

PMID33947346
PMCPMC8097804
OpenAlexW3158224806

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.