A randomized trial to evaluate primary care clinician training to use the Teachable Moment Communication Process for smoking cessation counseling

Sue Flocke, Mary M. Step, Elizabeth Antognoli, Peter J. Lawson, Samantha Smith, Brigid Jackson, Sue Krejci, Theodore Parran, Sybil Marsh

Research output: Contribution to journalArticle

11 Scopus citations


Objective: To implement and evaluate the impact of a Teachable Moment Communication Process (TMCP) training intervention on clinicians' smoking cessation counseling behaviors in practice. Method: 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). Conclusion: The intervention significantly changed the content of clinicians' smoking cessation communication in ways consistent with the TMCP model for health behavior change.

Original languageEnglish (US)
Pages (from-to)267-273
Number of pages7
JournalPreventive medicine
Publication statusPublished - Dec 1 2014
Externally publishedYes



  • Audio recordings
  • Brief advice
  • Cluster randomized trial
  • Primary care
  • Tobacco counseling

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

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