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Training physicians in behavioural change counseling: A systematic review.

Patient Educ Couns. 2019 01;102(1):12-24

Authors: Dragomir AI, Julien CA, Bacon SL, Boucher VG, Lavoie KL, Canadian Network for Health Behavior Change and Promotion (CAN-Change)

Abstract

BACKGROUND: Poor health behaviours (e.g., smoking, physical inactivity) represent major underlying causes of non-communicable chronic diseases (NCDs). Prescriptive behaviour change interventions employed by physicians show limited effectiveness. Physician training in evidence-based behaviour change counselling (BCC) may improve behavioural risk factor management, but the efficacy and feasibility of current programs remains unclear.

OBJECTIVE: (1) To systematically review the efficacy of BCC training programs for physicians, and (2) to describe program content, dose and structure, informing better design and dissemination.

METHODS: Using PRISMA guidelines, a database search up to January 2018, yielded 1889 unique articles, screened by 2 authors; 9 studies met inclusion criteria and were retained for analysis.

RESULTS: 100% of studies reported significant improvements in BCC skills among physicians, most programs targeting provider-patient collaboration, supporting patient autonomy, and use of open questions to elicit "change-talk". Limitation included: poor reporting quality, high program heterogeneity, small sample sizes, 78% of studies having no comparison group, and less than 30% of skills taught being formally assessed.

CONCLUSION: Training programs were efficacious, but methodological weaknesses limit the ability to determine content and delivery. Caution is necessary when interpreting the results.

PRACTICE IMPLICATIONS: Further research emphasizing rigorous training program development and testing is warranted.

PMID: 30172573 [PubMed - in process]