Helping Patients Change Flashcards
Ambivalence is a normal part of the process of behaviour change for the patient. What is this?
- maybe change, maybe not
- Can feel different at different appointments
What is the patients task in behaviour change?
- 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)
What is the clinicians role in behaviour change?
- To elicit the arguments for change
What can help to facilitate the process of behaviour change?
The use of specific skills such as agreeing on priorities
In a consultation what is the first step to begin the process of behaviour change?
- Create good rapport with the patient
- Research has shown that good rapport directly correlated with patient behaviour change outcomes
What are 5 different ways that we can establish good rapport?
- 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
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?
- Directing
- Following
- Guiding
What is the ‘directing’ communicating style? (4)
- 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
What is the following communication style? (3)
- 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
What is the ‘guiding’ communication style? (3)
- 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)
How do we identify the communication style we should use? (2)
- 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
If rapport is lost with a patient what can happen?
- If rapport is lost, patient can be uncomfortable, disengaged, confused and resistant
The 4 main communication skills for guiding styles are describes in the acronym OARS. What does this mean? (4)
- O for open questions (gives clinician deeper understanding of patients views)
- A for affirmation (I can see that… - demonstrate appreciation for patients efforts)
- R for reflective listening (I understand that… - enables listener to check what has been said by speaker)
- S for summary (so in summary…)
Dental clinicians should always ask permission to discuss health behaviour with patient, rather than just tell them. How might we do this? (3)
- 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
Why is it important to ask the patient questions? (4)
- 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
How can yo provide support to the patient? (2)
- Demonstrate appreciation for patient’s effort and reinforce positive acts
- Can build patient’s confidence that they can change
How do we convey an understanding to the patient?
- By using reflective listening
- e.g. it sounds like you are really trying and determined to give quitting a go
How might you get your information across to the patient? (3)
- 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
What is behaviour change counselling? (3)
- Slightly different technique/ approach to patients
- Brief form of motivational interviewing
- Should help with compliance
What are key features that are important in behaviour change counselling? (4)
- 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
There are 3 categories for patients in the cycle of behaviour change. What are these categories?
Pre-contemplators - not interested
Contemplators - wanting to do it some time in the future
Preparation - want to do it now
What is the cycle for behaviour change?
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
What are examples of habit changes that practitioners usually focus on? (4)
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
To establish rapport ask any question that might help you to understand the patient better. Give examples of these questions? (3)
- 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
It is important that an individual sees the value in the change. What questions could we ask them to assess this? (2)
- How do you feel at the moment about change…?
- How important is it to you personally…?
It is important that the individual is confident that they can change. What question could we ask to assess this?
- If you decide right now to (quit, reducing alcohol intake etc), how confident would you feel about succeeding on a scale of 1-10?
Which types of patient are more likely to be successful with behaviour change?
- Patients who have high importance and confidence, most likely to be successful
What questions might you ask to allow you to exchange information with the patient? (4)
- 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
If you can tell that a patient is showing resistance, what can you do to reduce resistance? (2)
- 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
