L2: Dr/Pt Relationship II Flashcards
What are factors that affect pt cooperation?
- Severity of illness and consequences (when high, more cooperation) - Susceptibility to disease (when high, more cooperation) - Capability of pt: are they capable to perform a particular behavior to reduce risk? - Confidence in treatment: if highly confident treatment will reduce risk, they will cooperate
What are helpful physician questions and behaviors appropriate to each stage of change?
1.) Precontemplation: - build relationship, express concern, no scare tactics, education in small bits – “teachable moments,” validate lack of readiness, facilitate self-exploration, establish pro v cons, roll with resistance, express concern, personalize risk factors - Q: How would you know if your…was a problem for you? - Q: If you were to decide to change, what do you imagine might be some advantages? 2.) Contemplation: - lift up pts assessment of pro v cons, raise consciousness, restate both sides of ambivalence, pose advice gently, elicit reasons for change, build and affirm self-efficacy, determine barriers / resistances - Q: What obstacles do you see that might hinder you in addressing this concern? - Q: What are some of the reasons you may not have been concerned about this before? - Q: How have you dealt with serious concerns before in your life? - Q: What are some personal resources that could be of help to you, should you decide to deal with this matter? 3.) Preparation: - encourage pts efforts, encourage small steps and define them with pt, ask about strategies pt will use in risk situations, ask about setting a change date - Q: What are some strategies you have in place should X arise? - Q: What do you think should be done first? 4.) Action: - reinforce the decision, build and facility increased self-efficacy, delight in small successes, view problems as helpful information, ask what else is needed for success - Q: Do you remember accomplishing X? - Q: What else do you think you could do to help continue X? 5.) Maintenance: - continue reinforcement and support, explore internal rewards and benefits from change, identify risks for relapse and helpful strategies to manage them, identify temptations - Q: This has been working really well for you. How do you feel? - Q: What are the biggest benefits to you after doing X? - Q: What temptations do you have while doing X? 6.) Relapse: (not technically stage, part of process) - learn from temporary success and use to re-engage pt in change process, remind pt change is a process and most ppl recycle, reframe relapse and don’t use failure – say successful for a while, identify and evaluate triggers, reassess motivation and obstacles, counter demoralization - Q: What was the most difficult thing for you during X? - Q: You were successful for X period of time, what are some of the obstacles in your way? - Q: Most people move back and forth through this process of change, what are some of the reasons you were successful for a while and reasons you weren’t?
What are key dimensions of helpful doctor/pt relationships? What are potential obstacles?
- Pt cooperation: depending on perceived severity of illness and consequences, pt will be more of less likely to cooperate. Cooperation increases if pt is capable of performing a behavior to reduce risk of increased severity of illness and if they are confident treatment being given will reduce risk. - Help pt make the issue their own, allow them to be actively engaged - Court resistance - Know that relapse is part of the change process - Develop sense of the direction the pt is moving and how to work with that, not against
List the stages of change.
- PCPAMR - P: precontemplation - C: contemplation - P: preparation - A: action - M: maintenance - R: relapse (not technically stage, part of process)
What are signs/suggestions of pt non-cooperation?
- dependency - manipulativeness - angry, demanding - withdrawn - fearful - depressed - help-rejecting
Describe the key features of the transtheoretical mode of change?
- Change is a process, not an event - Pt moves gradually from being uninterested to consider change to decided on change to preparing to make a change - People typically cycle through the stages of changes - Movement through stages can be facilitated by intervening in particular ways
Explain each of the central constructs to the TTM?
- Processes of change: a.) Cognitive/emotional: changing way ppl think / feel about health risk behavior in early stages eg. Think about deciding to quit than about quitting b.) Behavioral: change behavioral process to help ppl move through stages of change eg. Taking steps to change to maintaining change - Decisional balance: Pros vs Cons (progress vs regress): keeping balance toward positive/progress, but not at cost of ignoring cons/regress - Stages of change: (PCPAMR mnemonic) Precontemplation, contemplation, preparation, action, maintenance, relapse - Self-efficacy: Confidence in ability for pt to manage specific situation without returning to old behavior. What is the pt’s sense of their ability to accomplish something? - Temptation: Intensity of the urge to engage in a behavior in particular situations?
Describe the scope of non-cooperation.
- pts fail to keep bw 10-20% of appts made - pts fail to fill 30% of rxs written - pts on long-term meds for chronic dz take rx meds about 50% of time
What are potential obstacles to a helpful pt/doctor relationship?
- Cooperation - Engagement of pt (active vs passive) - Resistance - Relapse - Not knowing direction pt is moving
Explain briefly what each of the stages of change are. Provide timeframe to change.
- P: precontemplation: not really thinking about change (cons high, pros low) – not likely to change for 6 months - C: contemplation: recognizes problem and considering change “some day” (pros = cons) – likely to change in 6 months - P: preparation: ready, but some ambivalence may remain (pros > cons) – will take action within 1 month - A: action: real behavioral changes are occurring (pros >>> cons) – change in place is less than 6 months - M: maintenance: gains are consolidated, long and ongoing – change has been achieved for greater than 6 months - R: relapse: return to an earlier behavior (can occur during any time in the process) – not technically stage, but part of process
In what stage(s) are pts most receptive to information / education about condition and treatment?
- preparation and action stages
What are the central constructs that should be addressed in the transtheoretical model of change?
- Processes of change - Decisional balance - Stages of change - Self-efficacy - Temptation
What are techniques/advice to deal with non-compliance?
- look for reasons behind the pts non-compliance - view non-compliance as symptom required exploration into cause - Ask: What can this pt teach me that I need to know? Or How do I build a relationship with an angry person or a person who won’t tell me very much? - Elicit feedback from pt on their perceived ability to achieve a goal - Anticipate certain degree of non-cooperation in all pts (plan for it) - Support/empathy - Keep care inexpensive and simple
What is the transtheoretical model of change?
- It is an integrative, biopsychosocial model to conceptualize the process of intentional behavior change. It uses Stages of Change to integrate the most powerful principles and processes of change from leading theories of counseling and behavior change – developed from 35 years of research. Results of research funded by over $80 million.
