Self Management and Shared Decision Making Flashcards
What is Self-management
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
What is the role of the clinician in self management
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
Why is self management importatn
- 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
How many GP appointments account for long term conditions, outpatient appointments and inpatient bed days for long term patients
People with LTCs account for about 50% of all GP appointments, 64% of all outpatient appointments and over 70% of all inpatient bed days.
What needs to be managed in self management
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
How many people in the uK have a long term condition
15 million
What is the rates of medical adherence
- Published estimate of general adherence = 60%
What is the Average rate for taking medicine for acute illness with short term treatment
78%
What is the average rate for taking medicine for chronic illness with long term treatment
54%
What is the average rate for taking medicine to prevent illness
60%
What is the typical rate for lifestyle changes
2-10%
What models can be used to predict health behaviour
Health Belief Mode
Theory of Planned Behaviour
Transtheoretical Model (Stages of Change)
Social Cognitive Theory
What is the health belief model
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
Describe the theory of planned behaviour
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
Describe how the transtheoretical model of change works
- 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
What is the best predictor for quitting smoking
- the number of failed attempts they have had a changing the behaviour as they learn what to not do
Describe what 3 things make up the behaviour change wheel is made up of
Made up of;
- sources of behaviour
- intervention functions
- policy categories
What social changes facilitate self-management
- 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
Describe what behaviour change wheel is made up of
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
What makes self- management difficult
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
What are issues arising from the medical consultation
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:
What are concerns about medication
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
What is the difference between informed decision making and shared decision making
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
What is the difference between Dr centred and patient centred consultations
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
What is the point of the patient centred consultation
- 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
What are self management programmes
- 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
What is an expert patient programme
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
Why does the expert patient programme work
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
What is self help
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
What makes self help management groups work
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
