Mallett KA, Turrisi R, Guttman K, Read A, Billingsley E, Robinson J. Assessing Dermatologists ’ Ability to Deliver a Novel Intervention to Improve Patients ’ Use of Sun Protection: The ABC Method of Physician-Patient Communication. Arch Dermatol. 2011;147(12):1451-1453. doi:10.1001/archdermatol.2011.220
Author Affiliations: Prevention Research Center/Department of Biobehavioral Health, The Pennsylvania State University, University Park (Drs Mallett and Turrisi and Mss Guttman and Read); Department of Dermatology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey (Dr Billingsley); Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Dr Robinson).
Patients are often aware of the benefits of using sun protection, but this does not necessarily translate into positive behavioral outcomes. This disconnect can be a source of frustration for many dermatologists, who often emphasize the importance of proper sun protection to their patients. Research has shown that education alone is not an effective strategy to change behavior, especially among less motivated patients. However, communication that incorporates the principles of motivational interviewing (MI), a patient-centered approach that uses empathic communication, has been successful in improving a variety of health-related behaviors.1 While MI is often effective, most physicians are not familiar with this or similar communication techniques.2 Furthermore, most dermatologists have limited time to interact with patients during an office visit, making it difficult to engage in lengthy conversations about sun protection.
Research suggests that training physicians to express empathy to their patients is a promising area for further research with potential to improve patient care.3,4 A recent study found that dermatologists who were shown an example of physician-patient conversations about sun protection that used MI principles felt favorably toward the technique and thought it would be a useful communication tool.5 Based on these findings, we have developed the ABC (addressing behavior change) method as a communication tool for dermatologists to use with their patients to enhance the use of sunscreen. The ABC method is based on the principles of MI and consists of the following components: (1) assess UV risk; (2) assess sunscreen use; (3) assess the obstacles to using sunscreen; (4) facilitate removal of the obstacles to sunscreen use; (5) assess other methods of sun protection; and (6) summarize patients' motivations and ideas for improved sunscreen use. On average, the ABC method takes 2 to 3 minutes to deliver and was designed for use during a routine office visit that includes a skin examination. The ABC method is delivered in the context of a collaborative conversation with the patient rather than as a direct instruction.
The focus of the current study was to teach a sample of dermatologists the ABC method and assess their ability to deliver it with fidelity as well as their sustained use and satisfaction with using it over a 6-month period.
Participants consisted of 8 dermatologists at a medium-sized northeastern university teaching hospital. Participants were invited based on their availability during the mandatory training sessions and the appropriateness of their patient population (eg, adults receiving skin examinations). Participation was voluntary, and dermatologists were assured that whether or not they agreed to participate, their decision would have no impact on their departmental standing. Initially, 12 dermatologists met the inclusion criteria. Of those, 10 agreed to participate, 1 withdrew owing to a conflict, and 1 reported not using the intervention throughout the course of the study and so was not included in the analyses.
Participants completed 6 self-report surveys to assess frequency of using the ABC method and satisfaction with the method. To assess fidelity, participating physicians were audio recorded delivering the intervention during patient visits at 4 time points throughout the study (at baseline, immediately after training, and at 3- and 6-month follow-up visits). Participants were compensated with a $10 gift card for each of the 6 monthly progress surveys. The research protocol was approved by the Pennsylvania State University institutional review board.
Each participant attended two 1-hour training sessions to learn the ABC method after baseline data were collected. The first session was delivered in a group format during the departmental meeting of the weekly journal club. Didactic information was presented, and participants engaged in practice exercises. Participants were instructed to practice the intervention on their own for a week to learn the components. One week later, during the next journal club meeting, participating physicians engaged in role play exercises with mock patients. After the training, each physician participant was shadowed by a trainer while delivering the ABC method to actual patients in the clinic. Feedback was provided for at least 3 patients per physician. In addition, participants were given pocket-sized cards listing the intervention components to use as needed. Participants were then asked to use the ABC method with patients over the next 6 months. To assess whether participants successfully learned and delivered the ABC method, patient visits at baseline, immediately after training, and at 3- and 6-month follow-ups were coded for fidelity. A total of 109 sessions were coded over the 4 time points for all 8 participating dermatologists.
Across the study, physicians delivered the ABC method with good fidelity (Table 1), increased their use of the ABC method, gave uniformly high positive ratings of the ABC method on enhancing communication and comfort, and declared their intention to use the method after the study was completed (Table 2).
The present study shows that dermatologists learned and delivered the ABC method of physician-patient communication with good fidelity over a sustained period of time. Dermatologists learned the method during existing educational sessions. Furthermore, using the ABC method did not add length to the office visit. This method was often used as a way to build rapport with patients and replaced conversation that was less relevant to patient behavior. Participating dermatologists also reported high satisfaction with the ABC method and unanimously stated that they intended to use it in the future. Overall, the findings suggest that the ABC method is a feasible way for dermatologists to communicate with patients about sun protection during an office visit. Future studies will examine the ABC method in relation to patient outcomes to determine if this technique translates to positive changes in patients' sun-protection behavior and patient satisfaction.
Correspondence: Dr Mallett, Prevention Research Center, The Pennsylvania State University, 204 E Calder Way, Ste 208, State College, PA 16801 (firstname.lastname@example.org).
Accepted for Publication: June 18, 2011.
Published Online: August 15, 2011. doi:10.1001/archdermatol.2011.220
Author Contributions: Drs Mallett and Turrisi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Mallett, Turrisi, Billingsley, and Robinson. Acquisition of data: Mallett, Turrisi, Guttman, and Read. Analysis and interpretation of data: Mallett and Guttman. Drafting of the manuscript: Mallett and Guttman. Critical revision of the manuscript for important intellectual content: Mallett, Turrisi, Read, Billingsley, and Robinson. Statistical analysis: Mallett and Turrisi. Obtained funding: Mallett. Administrative, technical, and material support: Guttman and Read. Study supervision: Mallett, Turrisi, Billingsley, and Robinson.
Financial Disclosure: None reported
Funding/Support: This study was supported in part by National Cancer Institute grant R03 CA144435 (Dr Mallett).
Disclaimer: Dr Robinson is editor of the Archives of Dermatology but was not involved in the editorial evaluation or decision to publish this article.