Table 8 (NYU): fidelity counseling audio review form

1. Treatment Alliance/Non-specific effects

 Outlines program for patients, obtains buy-in and forms working relationship.

 Demonstrates warmth. (E.g., “I can understand how you feel.”) Took a personal interest in pt.

 Demonstrates credibility. “E.g., “Many patients have found that distracting themselves by doing something pleasant can help them deal with the urge to smoke.”

 Minimizes non-relevant (e.g., non-smoking-related) conversation. (E.g., “I hear what you’re saying (reflect/summarize). Let’s shift and talk about your smoking.”

 Comments:

2. Assessment

 Obtained history of smoking

 Environment: Assesses smoking at home and among friends and family

 Elicited pros and cons of smoking

 Elicited personal psychological/habit/physical components of addiction

 Discussed motivation to quit and helped patient expand on meaning of their reasons. “You mentioned health, what would be different if you had better health?” “What are some reasons that’s important for you?”

 Discussed confidence in ability to quit

 Comments:

3. Counseling Skills

 Asks more open-ended questions. (E.g., “Let’s spend a few minutes talking about your quit date. Can you tell me about the plan for this day?”)

 Encourages change talk from patient (e.g., less talking by TTS and more listening). Rule of thumb: Patient should talk 3 times as much as the counselor.

 Asks one question at a time.

 Corrects assumptions and uses Elicit-Provide-Elicit framework (E.g., “May I tell you a little about the effects of smoking on ----?” “Actually, that’s what many people think, can I tell you more about that?”

 Uses empathic listening statements to Affirm patient’s experience (reflection: simple, complex as needed)

 Uses summaries/transition statements when introducing a new topic/idea. E.g., “I understand that you want to quit because of your health and for your children. These are very important reasons. Let’s switch to a different, but related topic and discuss some reasons why you like smoking.”

 Comments:

4. Cessation Planning

 Elicited patient ideas and exchanges information about quit plan, including correcting assumptions.

 Discusses NRT – past use, type of use, corrected assumptions

 Helped patient set behavioral goals and a quit date

 Identified triggers for smoking (psychological/habit/physical) and environmental (family, friends who smoke)

 Helped patient identify strategies for coping with triggers

 Asks patient to review upcoming plan for the week in their own words/check in re understanding

 Gives encouragement. (E.g., “I know you can do this, and I’ll be here to help you.”)

 Reviews number of remaining sessions

 Problem-solving (follow up calls)

 Examines slip or relapse situations

 Discuss and normalize withdrawal symptoms

 Develops patient self-image as a non-smoker

 Comments:

5. Adaptivity

 Tailors the content of counseling to patient needs (e.g., active/passive engagement style; information-seeking/avoidant; psychologically distressed/non-distressed; motivated/unmotivated.) E.g., Mental health/anxious patients may have difficulties with problem-solving and follow-through. These patients may need a more directive approach. Patients who are information-seeking may have lots of questions; TTS is able to answer these but can keep the counseling on course. Meets the patient where he/she is at.

 Tailors the content of counseling according to the session flow (e.g., fluidity, flexibility). If a patient has quit, and more time is spent talking about NRT, then spend a little less time on motivation building.

 Comments: