Self Management and Shared Decision Making

Question 1

What is Self-management

Answer 1

Taking charge of one’s health

Dealing with symptoms and change over time

Working more effectively with healthcare professionals

Improving one’s quality of life

Question 2

What is the role of the clinician in self management

Answer 2

9 (b) Discuss psychological concepts of health, illness and disease

c) Apply theoretical frameworks of psychology to explain the varied responses of individuals, groups and societies to diseases
d) Explain psychological factors that contribute to illness, the course of disease and success of treatment.
(e) Discuss psychological aspects of behavioural change and treatment compliance.

14 (h) Support patients in caring for themselves

Question 3

Why is self management importatn

Answer 3

• there is an increase in long term conditions
• people with long term conditions account for 50% of all GP appointments
• Multiple morbidity is more common in people who are over 60 and those who live in deprived areas
• people who live in deprived areas are more likely to develop long term health conditions earlier than in more affluent areas

Question 4

How many GP appointments account for long term conditions, outpatient appointments and inpatient bed days for long term patients

Answer 4

People with LTCs account for about 50% of all GP appointments, 64% of all outpatient appointments and over 70% of all inpatient bed days.

Question 5

What needs to be managed in self management

Answer 5

Monitoring of symptoms and responding appropriately

Taking Medications

Making Behavioural Changes

Making Role Adjustments

Managing Emotional Impact

Negotiating with Medical Team

Decision Making

Accepting Condition

Question 6

How many people in the uK have a long term condition

Answer 6

15 million

Question 7

What is the rates of medical adherence

Answer 7

• Published estimate of general adherence = 60%

Question 8

What is the Average rate for taking medicine for acute illness with short term treatment

Answer 8

78%

Question 9

What is the average rate for taking medicine for chronic illness with long term treatment

Answer 9

54%

Question 10

What is the average rate for taking medicine to prevent illness

Answer 10

60%

Question 11

What is the typical rate for lifestyle changes

Answer 11

2-10%

Question 12

What models can be used to predict health behaviour

Answer 12

Health Belief Mode

Theory of Planned Behaviour

Transtheoretical Model (Stages 
of Change)

Social Cognitive Theory

Question 13

What is the health belief model

Answer 13

Threat perception and the benefits and costs of the behaviour feed into the idea whether the patient takes action or not, health motivation (do i value health) and cues to action (what triggers to action are there) also feed in to take action and and be the products of taking action

• Perceived susceptibility (How likely am i to face a problem) and perceived severity (how serious is the problem) leads into threat perception

Question 14

Describe the theory of planned behaviour

Answer 14

there are attitudes (overall evaluation of an action) and subjective norm (beliefs about others approval of the action) and this leads to the intention which is how hard i intend to try and change my behaviour

• this can lead to a change in behaviour
• there is also the perceived behavioural control (persons assessment of their ability to undertake action) which leads to intention and behaviour changed

Question 15

Describe how the transtheoretical model of change works

Answer 15

• Pre-comtemplation - this is when you have no intention of changing behaviour
• Contemplation - aware of a problem exists, no commitment to action
• preparation - intent upon taking action
• action - active modification of behaviour
• maintenance - sustained change - new behaviour replaces the old
• relapse - this is when you fall back into the old patterns of behaviour
• then pre-contemplation again

Question 16

What is the best predictor for quitting smoking

Answer 16

• the number of failed attempts they have had a changing the behaviour as they learn what to not do

Question 17

Describe what 3 things make up the behaviour change wheel is made up of

Answer 17

Made up of;

• sources of behaviour
• intervention functions
• policy categories

Question 18

What social changes facilitate self-management

Answer 18

• Increased (but not universal) access to telephones and the internet
• DoH emphasis on primary prevention since 1991, increased promotion of self-checking behaviours, engaging with healthy lifestyles, mass media campaigns such as Change4Life.
• Since the 1960s and 70s – rejection of paternalistic models of care, rise of empowerment movements
• Changes in social attitudes to smoking, obesity and so on
• Legal changes such as the smoking ban, sugar tax

Question 19

Describe what behaviour change wheel is made up of

Answer 19

Sources of behaviour

• opportunity
• capability
• motivation

Intervention functions

• Environmental restricting – if you want people to walk give people a place to walk in
• Restrictions – put smoking cigarettes behind the counter
• Education
• Persuasion
• Incentivisation
• Coercion
• Training
• Enablement
• Modelling

Policy Categories

• fiscal measures
• guidlines
• environmental social planning
• communication
• legislation
• service provision
• regulation

Question 20

What makes self- management difficult

Answer 20

Issues of understanding and remembering

Regimes may be complex and changing

Regime may require changing long term habits like smoking

Not everyone wants to self-manage

People often don’t self-manage chronic conditions very well and lose motivation

Often have more than one condition e.g. diabetes and CHD

Lack of social support

Environment affects attempts to maintain lifestyle changes such as healthy eating and exercise etc

Financial barriers to adherence

Question 21

What are issues arising from the medical consultation

Answer 21

Failure to agree on a diagnosis

Lack of agreement about the correct treatment

Dissatisfaction with the interaction – where patients feel they have not been listened to:

Question 22

What are concerns about medication

Answer 22

Concerns about side effects

Worries about dependency

Beliefs about what is ‘natural’ and ‘unnatural’

Disruption to lifestyle – taking medication every day, at certain times of day

Question 23

What is the difference between informed decision making and shared decision making

Answer 23

Informed decision making

• Dr gives patient all the factual/medical information they need about treatments
• Patient decides what treatment/management to have
• Dr provides treatment/management

Shared decision making

• Dr and patient are both involved
• Dr and patient discuss possible treatment/management options
• Dr gives expert opinion/recommendation
• Dr and patient decide on treatment/management together

Question 24

What is the difference between Dr centred and patient centred consultations

Answer 24

Dr centred

• Dr talks and patients listens
• Dr makes decisions and tells patient what to do

Patient centred consultation

• Patient expresses own agenda
• Dr uses active listening to understand the patients point of view
• Dr and patient agree on diagnosis and management

Question 25

What is the point of the patient centred consultation

Answer 25

• Should improve adherence, the patient feels that they have been heard it addresses the two agendas (doctor and patients) and improves satis-action
• more likely to prescribe a regime that they patient understands can follow

Question 26

What are self management programmes

Answer 26

• patient can learn to manage their illnesses in such a way to have best control over symptoms and health related quality of life
• can be used for long term conditions
• based on CBT
• increasingly tailored programmes are offered
• usually involves behaviour change of some kind so based on theories of behaviour changes

Question 27

What is an expert patient programme

Answer 27

This is a programme (can last 6 weeks) that is there to teach patients with a long term health condition such as asthma or diabetes how to manage there conditions

Question 28

Why does the expert patient programme work

Answer 28

Based on theory – Social Cognition and Social Learning Theory (Bandura 1977)

Increase confidence by setting and achieving goals (self-efficacy)

Improve quality of life by helping patient feeling more in control of their condition because patients often know more about their chronic condition than the HCP so they can be empowered to use their knowledge

Teaching patients how to communicate better about their condition should improve the quality of doctor-patient interactions for both parties.

Patients are often experts on their condition

Question 29

What is self help

Answer 29

Can mean joining a group of people with similar health issues

Can equally take on the form of books, DVDs, online courses, virtual groups/forums

Groups can be peer or expert led

Can be carried out by individuals who would rather not join a group

Question 30

What makes self help management groups work

Answer 30

Normalising conditions, sharing experiences

Sharing knowledge and resources – equality among members

Emotional support – especially in terms of removing stigma and offering a safe space

Learning from those who have had the condition longer

Space to construct a narrative of the illness, sharing stories

A place to talk honestly without upsetting family members