Helping Patients Change

Question 1

Ambivalence is a normal part of the process of behaviour change for the patient. What is this?

Answer 1

• maybe change, maybe not

- Can feel different at different appointments

Question 2

What is the patients task in behaviour change?

Answer 2

• To say how and when they should change (this is up to the patient - you will not stop someone from smoking if they don’t want to)

Question 3

What is the clinicians role in behaviour change?

Answer 3

• To elicit the arguments for change

Question 4

What can help to facilitate the process of behaviour change?

Answer 4

The use of specific skills such as agreeing on priorities

Question 5

In a consultation what is the first step to begin the process of behaviour change?

Answer 5

• Create good rapport with the patient

- Research has shown that good rapport directly correlated with patient behaviour change outcomes

Question 6

What are 5 different ways that we can establish good rapport?

Answer 6

• Smile and welcome patients into appts
• Think about your non-verbal’s
• Think about when you ask questions
• Take time to listen to patients
• Make them comfortable enough to come back in the future

Question 7

Selecting the right style of communication for a given consultation is often the key to creating and maintaining rapport. What are the 3 consulting styles?

Answer 7

• Directing
• Following
• Guiding

Question 8

What is the ‘directing’ communicating style? (4)

Answer 8

• 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

Question 9

What is the following communication style? (3)

Answer 9

• 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 the patients problem immediately
• Aims to provide support and encouragement in difficult situations such as breaking bad news

Question 10

What is the ‘guiding’ communication style? (3)

Answer 10

• More complex than the other 2
• 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)

Question 11

How do we identify the communication style we should use? (2)

Answer 11

• Skilled judgement is used to identify type used in visit and be able to switch when required
• If rapport is lost, patient can be uncomfortable, disengaged, confused, resistant

Question 12

If rapport is lost with a patient what can happen?

Answer 12

• If rapport is lost, patient can be uncomfortable, disengaged, confused and resistant

Question 13

The 4 main communication skills for guiding styles are describes in the acronym OARS. What does this mean? (4)

Answer 13

1. O for open questions (gives clinician deeper understanding of patients views)
2. A for affirmation (I can see that… - demonstrate appreciation for patients efforts)
3. R for reflective listening (I understand that… - enables listener to check what has been said by speaker)
4. S for summary (so in summary…)

Question 14

Dental clinicians should always ask permission to discuss health behaviour with patient, rather than just tell them. How might we do this? (3)

Answer 14

• 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

Question 15

Why is it important to ask the patient questions? (4)

Answer 15

• Provides valuable clinical information
• Give the opportunity for patient perspective
• Gives an insight into factors affecting change
• Helps the clinician to understand why patient may behave in a certain way

Question 16

How can yo provide support to the patient? (2)

Answer 16

• Demonstrate appreciation for patient’s effort and reinforce positive acts
• Can build patient’s confidence that they can change

Question 17

How do we convey an understanding to the patient?

Answer 17

• By using reflective listening

- e.g. it sounds like you are really trying and determined to give quitting a go

Question 18

How might you get your information across to the patient? (3)

Answer 18

• Asses what the patient already knows
• Provide further information
• Find out what information means for the patient (check that the info they have in their heads is right)
• This should all be done very sensitively

Question 19

What is behaviour change counselling? (3)

Answer 19

• Slightly different technique/ approach to patients
• Brief form of motivational interviewing
• Should help with compliance

Question 20

What are key features that are important in behaviour change counselling? (4)

Answer 20

• 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

Question 21

There are 3 categories for patients in the cycle of behaviour change. What are these categories?

Answer 21

Pre-contemplators - not interested

Contemplators - wanting to do it some time in the future

Preparation - want to do it now

Question 22

What is the cycle for behaviour change?

Answer 22

Precontemplation ->
Contemplation ->
Preparation ->
Action ->
Maintenance 

• People move through this cycle (not necessarily linearly)
• May have to go round cycle several times before they actually manage to quit

Question 23

What are examples of habit changes that practitioners usually focus on? (4)

Answer 23

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

Question 24

To establish rapport ask any question that might help you to understand the patient better. Give examples of these questions? (3)

Answer 24

• Can you take me through a typical day… With regards to smoking, wee jeanies diet, with your alcohol intake
• Use of smoking, diet diaries
• Various apps, wearable technology

Question 25

It is important that an individual sees the value in the change. What questions could we ask them to assess this? (2)

Answer 25

• How do you feel at the moment about change…?

- How important is it to you personally…?

Question 26

It is important that the individual is confident that they can change. What question could we ask to assess this?

Answer 26

• If you decide right now to (quit, reducing alcohol intake etc), how confident would you feel about succeeding on a scale of 1-10?

Question 27

Which types of patient are more likely to be successful with behaviour change?

Answer 27

• Patients who have high importance and confidence, most likely to be successful

Question 28

What questions might you ask to allow you to exchange information with the patient? (4)

Answer 28

• 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

Question 29

If you can tell that a patient is showing resistance, what can you do to reduce resistance? (2)

Answer 29

• Emphasise personal choice and control
• Back off and come alongside the patient

E.g. It’s completely up to you understand it’s an incredibly difficult thing to do to stop smoking. But we can consider if this isn’t the right time for you. I’ll put it in the notes and maybe next time you’re in for a check-up we can think about it then