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BDS3 PMHP > Communication 1 - Helping people change > Flashcards

Communication 1 - Helping people change Flashcards

1
Q

behaviour change

A

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

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2
Q

patients task in behaviour change

A

say how and when they should change

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3
Q

clinicians role in behaviour change

A

elicit these arguments for change

Use of specific skills such as agreeing on priorities can facilitate this process

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4
Q

example of model/theory for behaviour change

A

many
(links with Dr Al Ross /COMB model)

Can be complicated!

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5
Q

relationship between the clinician and the patient

A

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.
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6
Q

how to create good rapport with patient

A
  • 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.
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7
Q

3 consulting styles

A

directing

following

guiding

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8
Q

importance of consulting styles in communication

A

key to creating and maintaining rapport.

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9
Q

directing style

A

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

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10
Q

following style

A

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)

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11
Q

guiding style

A

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

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12
Q

4 main communication skills for guiding style in health behaviour change

A

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)

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13
Q

O in OARS for guiding style communication

A

for open questions

Gives clinician deeper understanding of patient’s views

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14
Q

A in OARS for guiding style communication

A

for affirmation – (I can see that…)

Demonstrate appreciation for patient’s efforts

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15
Q

R in OARS for guiding style communication

A

for reflective listening - (I understand that…)

Enables listener to check what has been said by the

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16
Q

S in OARS for guiding style communication

A

is for summary - (So in summary, I)

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17
Q

is the pt happy to talk to you about behaviour change

A

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.

18
Q

how are you asking questions?

A

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
19
Q

how do you provide support?

A

‘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

20
Q

how do you convey understanding?

A

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

21
Q

how do you get your information across

A

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….?
22
Q

how do you bring it all together

A

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

23
Q

behaviour change counselling

A

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
24
Q

cycle of behaviour change

A 
precontemplation -> 
contemplation -> 
preparation -> 
action ->
maintenance
25
Q

precontemplators in cycle of behaviour change

A

not interested

start

26
Q

contemplatprs in cycle of behaviour change

A

wanting to do it some time in the future

mildly interested / middle

27
Q

preparation in cycle of behaviour change

A

want to do it now

end

28
Q

4 changes in behaviour practitioners focus on

A

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

29
Q

how does behaviour change cycle startq

A

establish rapport

set agenda
(single behaviour)

assess importance and confidence (and readiness)

30
Q

establish rapport

A 
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

31
Q

set an agenda

A

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

32
Q

2 components of readiness to change

A

importance

confidence

33
Q

importance in readiness to change

A

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

34
Q

confidence in readiness to change

A

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

35
Q

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

A

high confidence

low importance

36
Q

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

A

high importance

low confidence

Want better but doubt their ability to do so

alike smokers often

37
Q

what pt are most likely to be successful in behaviour change

A

high importance and high confidence = therefore more ready

38
Q

2 ongoing tasks in behaviour change technique

A

exchange information

reduce resistance

39
Q

exchange information and behaviour change technique

A

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

40
Q

resistance and behaviour change technique

A

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

41
Q

how to reduce resistance in pt

A
  • 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

42
Q

key tasks in consultation about behaviour change/ behaviour change technique

A

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

BDS3 PMHP (14 decks)

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