Communication 1 - Helping people change Flashcards
behaviour change
complex and can be a struggle for both Patient and clinician
Ways of approaching health behaviour change to make it less stressful for the clinician
Limits to what can be achieved with advice alone
Ambivalence (maybe change, maybe not) is normal part of the process for the patient
How YOU communicate makes all the difference
patients task in behaviour change
say how and when they should change
clinicians role in behaviour change
elicit these arguments for change
Use of specific skills such as agreeing on priorities can facilitate this process
example of model/theory for behaviour change
many
(links with Dr Al Ross /COMB model)
Can be complicated!
relationship between the clinician and the patient
consultation first step is create good ‘rapport’ with the patient
- Research has shown that good rapport directly correlates with patient behaviour change outcomes.
- Smile and welcome patients into appts
- Think about your non-verbals
- Think about when you ask questions
- Take time to listen to patients
- Make them comfortable enough to come back in the future.
how to create good rapport with patient
- Smile and welcome patients into appts
- Think about your non-verbals
- Think about when you ask questions
- Take time to listen to patients
- Make them comfortable enough to come back in the future.
3 consulting styles
directing
following
guiding
importance of consulting styles in communication
key to creating and maintaining rapport.
directing style
Delivery of expert advice
Traditionally dominant within healthcare
Best employed when there is good rapport between patient and dentist
Should be well timed, personally relevant and delivered in such a way as to engage the patient
following style
Utilising listening skills, and occurs in situations where sensitivity is required such as when patient is upset.
goal of the clinician is not to solve patient’s problems immediately
aims to provide support and encouragement in difficult situations such as breaking bad news
(Spikes etc will deal with in advanced communication)
guiding style
More complex than other two
Patient and clinician work together to help the patient identify his or her goals, and how they might be achieved
Useful for those unsure about change (ambivalent)
Skilled judgement is used to identify type used in visit and be able to switch when required
If rapport is lost, patient can be
4 main communication skills for guiding style in health behaviour change
O for open questions
A for affirmation – (I can see that…)
R for reflective listening - (I understand that…)
S is for summary - (So in summary, I)
O in OARS for guiding style communication
for open questions
Gives clinician deeper understanding of patient’s views
A in OARS for guiding style communication
for affirmation – (I can see that…)
Demonstrate appreciation for patient’s efforts
R in OARS for guiding style communication
for reflective listening - (I understand that…)
Enables listener to check what has been said by the
S in OARS for guiding style communication
is for summary - (So in summary, I)
is the pt happy to talk to you about behaviour change
Dental clinician should always ask permission to discuss health behaviour with patient, rather than just telling them
- ‘How do you feel about having a quick chat about your smoking..’
- ‘There are a number of things we could talk about today. I’m just wondering if there is anything related to your oral health that you would like to talk about…..
Invite, not force, patient to discuss behaviour change
Ask simple questions about how the patient would feel to talk about behaviour change.
If multiple issues need to be addressed, encourage patient to select the one they want to deal with most.
how are you asking questions?
information gathering phase
- ‘How are you managing with your flossing’
- How do you feel about your smoking?
- How are you getting on with not giving wee Senga the bottle of juice at bedtime?
Provides valuable clinical information
- Gives the opportunity for patient perspective
- Gives an insight into factors affecting change
- Helps the clinician understand why patient may behave in a certain way
how do you provide support?
‘You took the time to think this through…
‘You’ve thought about how you might handle things
‘You’ve managed to cut your smoking..
‘You’ve managed to keep up the flossing though you find it a bit of a struggle…
Demonstrates appreciation for patient’s effort and reinforces positive acts
Can build patient’s confidence that they can change
- people respond to positive responses better than negative shaming
how do you convey understanding?
Reflective listening
- ‘It sounds like you…are doing well with the floss and interdental brushes…….
- ‘It sounds like you really are trying and determined to give quitting a go…….
- ‘It sounds like you are controlling wee Fraser’s sugar intake during the day, that’s good you’ve switched away from the coke in the bottle….
Check information is understood in the right way
what the speaker says -> the words the speaker says -> the words the listener hears -> what the listener thinks the speaker means
how do you get your information across
Assess what the patient already knows
- ‘What do you know about
- How much do you know about…
Provide further information
- ‘Some patients find that…
- ‘Research has shown that…
- ‘One thing that improves this condition is….
Find out what information means for the patient
- ‘What does this mean for you…?
- ‘What do you understand from….?
how do you bring it all together
Summary
- ‘So , you’ve been finding that your gums are bleeding when you brush your teeth, for some time. Until you saw a recent advertisement about gum disease, you thought that this was pretty normal, but now you’ve started to feel a bit worried. You have tried different mouthwashes. No improvement noted. You don’t know what else you can do, and hope I might be able to help you with this’…..’
Some pt use social media for information – need to try and correct inaccurate views
change isnt easy - be empathetic
behaviour change counselling
Slightly different technique / approach to patients
Brief form of motivational interviewing (MI)
Should help with compliance
- Not blaming them for their ill health (victim blaming)
Patient-centred method
- Directive-practitioners are encouraged to provide clear structure to consultation
- Negotiation-patient encouraged to make positive changes in collaboration with practitioner
cycle of behaviour change
precontemplation -> contemplation -> preparation -> action -> maintenance
