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
precontemplators in cycle of behaviour change
not interested
start
contemplatprs in cycle of behaviour change
wanting to do it some time in the future
mildly interested / middle
preparation in cycle of behaviour change
want to do it now
end
4 changes in behaviour practitioners focus on
Eat less, different foods
- frequency of sugar, amount, type
Drink less, abstain
- alcohol, coffee, drugs
Smoke fewer cigarettes
- quit, give up chew tobacco
Take up / modify OHI
- frequency, techniques in interdental cleaning
how does behaviour change cycle startq
establish rapport
set agenda
(single behaviour)
assess importance and confidence (and readiness)
establish rapport
Any question that might help you understand the patient better: ‘Can you take me through a typical day…. with regards to your - - smoking, - wee Jeanies diet….. - with your alcohol intake’
Use of smoking, diet diaries,
Various apps, wearable technology
set an agenda
Single or multiple?
Multiple behaviours
- smoking and alcohol, patient at risk of oral cancer
- obesity, diet (food restriction) increase exercise
Diet and toothbrushing
- in high caries rate child with suboptimal oral hygiene and +++ sucrose
Or singly
- diet, take up exercise, oral hygiene, smoking cessation
2 components of readiness to change
importance
confidence
importance in readiness to change
Individual has to see value in change
- ‘How do you feel at the moment about change…?’
- ‘How important is it to you personally….?’
why should i change
- personal values and expectations of the importance of change
confidence in readiness to change
Individual has to be confident that they can change (self efficacy)
- ‘If you decided right now to….[quit, reducing alcohol intake], how confident would you feel about succeeding…?
- On a scale of 1-10……
How will i do it
self efficacy
Dave is 23, and smokes only at weekends, usually when he’s out with friends.
‘I don’t see my smoking as a problem….I’m not addicted and it doesn’t bother me if I don’t have a packet on me. I can quit at any time, and probably will soon when I’m saving for a house….’
confidence and importance levels
high confidence
low importance
Susan is a mother of two children, 2 and 6. Her first child had a lot of decay, and she wants the teeth of her second child to be better.
However, this child is a restless sleeper, and is only settled by a bottle (containing a variety of cariogenic liquids) at night.
‘I really want C.’s teeth to be better and I know that I should cut out feeding him during the night, but I’m not sure that I can cope with the screaming………’
importance and confidence levels
high importance
low confidence
Want better but doubt their ability to do so
alike smokers often
what pt are most likely to be successful in behaviour change
high importance and high confidence = therefore more ready
2 ongoing tasks in behaviour change technique
exchange information
reduce resistance
exchange information and behaviour change technique
Would you like to know more about…?
How much do you already know about…?
Do you know about…?
Can I say to you…?
On patients’ terms, pitched at the right level
resistance and behaviour change technique
Have you misjudged the patient’s feelings about readiness, importance and confidence?
Are you meeting force with force? Are you being too confrontational?
To reduce resistance:
- Emphasise personal choice and control
- Back off and come alongside the patient
Say consider difficult thing and may not be the right time for you to try and do so now – I’ll put it in my notes and we can reflect on it another day
how to reduce resistance in pt
- Emphasise personal choice and control
- Back off and come alongside the patient
Say consider difficult thing and may not be the right time for you to try and do so now – I’ll put it in my notes and we can reflect on it another day
key tasks in consultation about behaviour change/ behaviour change technique
establish rapport ->
set agenda ->
(multiple/single behaviours)
assess importance and confidence (and readiness)
explore importance and build confidence
all the time - exchanging information and reducing resistance
