New Report Cites Importance of Doctor-Patient Collaboration in Changing Unhealthy Behavior

05/03/02    Portland, Ore.

A new report has a message for health care providers: Clinicians can make a difference in helping patients break old habits and adopt a healthier lifestyle, but they need to do more than simply tell patients what to do. And that's potentially a powerful weapon against half the causes of death in the United States.

The report notes that steps such as agreeing on a plan of action with each patient, providing additional assistance such as referral to community resources and arranging regular follow-up are all important steps to make counseling effective. The article is published in the May 2002 issue of the American Journal of Preventive Medicine.

"This article speaks to clinicians and policy-makers," said author Evelyn Whitlock, M.D., M.P.H., clinical associate professor at the Oregon Health & Science University Evidence-based Practice Center and senior investigator at the Kaiser Permanente Center for Health Research. The report, commissioned by the federal Agency for Healthcare Research and Quality (AHRQ), cites studies showing that nearly half the top 10 causes of death in the United States are due to lifestyle behavior, such as tobacco use, poor diet, illicit drug use, risky sexual practices, lack of exercise and alcohol misuse.

The report reviewed the growing body of research on behavioral interventions in the clinical arena and found that, while no simple model captures the broad range of intervention components across risk behaviors, the so-called "Five A's" construct adapted from tobacco cessation interventions -- assess, advise, agree, assist and arrange -- provides a workable framework to report behavioral counseling intervention review findings.

Despite its evident importance, behavioral counseling is not a usual part of health care, according to Whitlock. "Part of the reason is that behavioral counseling is outside the training of most clinicians," she said. "There's also been a paucity of good research evidence to support behavioral counseling interventions, although this is changing. We ultimately hope to improve the interest and ability of clinicians to appropriately counsel their primary care patients about health-related behaviors."

Although some clinicians are hesitant to address these "personal" issues with patients, the report offers evidence that well-delivered advice can enhance the patient's motivation to change.

AHRQ convenes the U.S. Preventive Services Task Force (USPSTF), an independent, private sector panel that reviews the medical literature to create recommendations for specific clinical preventive services. The Counseling and Behavioral Interventions Work Group of the USPSTF was convened to address adapting existing USPSTF methods to issues and challenges raised by behavioral counseling intervention topical reviews.

The group recognized a twofold need:

  • to expand its evidence-based approach to better assess behavioral counseling interventions, and
  • to formulate practical communication strategies for describing services that are effective in changing behavior.

This report is available at