Flocke Susan A, Clark Elizabeth, Antognoli Elizabeth, Mason Mary Jane, Lawson Peter J, Smith Samantha, Cohen Deborah J
Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA; Department of Epidemiology & Biostatistics, Case Western Reserve University School of Medicine, Cleveland, USA; Case Comprehensive Cancer Center, Cleveland, USA.
Department of Family Medicine, University of Medicine and Dentistry of New Jersey, New Brunswick, USA.
Patient Educ Couns. 2014 Jul;96(1):43-9. doi: 10.1016/j.pec.2014.03.014. Epub 2014 May 1.
Teachable moments (TM) are opportunities created through physician-patient interaction and used to encourage patients to change unhealthy behaviors. We examine the effectiveness of TMs to increase patients' recall of advice, motivation to modify behavior, and behavior change.
A mixed-method observational study of 811 patient visits to 28 primary care clinicians used audio-recordings of visits to identify TMs and other types of advice in health behavior change talk. Patient surveys assessed smoking, exercise, fruit/vegetable consumption, height, weight, and readiness for change prior to the observed visit and 6-weeks post-visit.
Compared to other identified categories of advice (i.e. missed opportunities or teachable moment attempts), recall was greatest after TMs occurred (83% vs. 49-74%). TMs had the greatest proportion of patients change in importance and confidence and increase readiness to change; however differences were small. TMs had greater positive behavior change scores than other categories of advice; however, this pattern was statistically non-significant and was not observed for BMI change.
TMs have a greater positive influence on several intermediate markers of patient behavior change compared to other categories of advice.
TMs show promise as an approach for clinicians to discuss behavior change with patients efficiently and effectively.
可教时刻（TM）是通过医患互动创造的机会，用于鼓励患者改变不健康行为。我们研究可教时刻在提高患者对建议的记忆、改变行为的动机以及行为改变方面的有效性。
一项对28名初级保健临床医生的811次患者就诊进行的混合方法观察性研究，利用就诊录音来识别健康行为改变谈话中的可教时刻和其他类型的建议。患者调查评估了在观察到的就诊前和就诊后6周的吸烟、运动、水果/蔬菜消费、身高、体重以及改变的准备情况。
与其他确定的建议类别（即错失的机会或可教时刻尝试）相比，可教时刻出现后的记忆效果最佳（83%对49%-74%）。可教时刻中，改变重要性和信心以及提高改变准备程度的患者比例最高；然而差异较小。与其他建议类别相比，可教时刻的积极行为改变得分更高；然而，这种模式在统计学上不显著，且体重指数（BMI）变化未观察到这种模式。
与其他建议类别相比，可教时刻对患者行为改变的几个中间指标有更大的积极影响。
可教时刻有望成为临床医生与患者有效且高效地讨论行为改变的一种方法。
