1. Helping Patients With Change Including Supportive Communication and Choosing an Appropriate Response Rachel Ogden December 2, 2010

2. Change One of the few constants in life Individuals differ in their comfort level with change Given the choice – most people would rather prove why its not necessary to change rather than change It is normal for people to resist change until they believe is actually good for them

3. Example Pt with a diagnosis of Diabetes Mellitus II Lifestyle changes need to occur The actual administration of the medications Then you must consider the monitoring involved

4. Emotional Responses to Change Fear, anxiety, ambivalence Anger, blaming and scapegoating Going numb, or avoidance Excitement, joy, relief Depression, both existential and clinical

5. Patient’s Readiness to change Transtheoretical Model of Change Listed the steps of process in previous lecture Another method of assessment and way to educate the patient is: Motivational Interviewing

6. Motivational Interviewing Allows patient to not feel as though they are being scolded when they have concerns or questions or resistance Pharmacists see resistance as a pathway to information Attempts to allow the patient not to lose “face” COMPETENCE FACE AUTONOMY FACE

7. Motivational Interviewing When we are talking to patients we can’t always assume that we know what their life is like or that we can predict what their questions or challenges would be. Pharmacists can also explore the ambivalence a patient may portray Once again – ask questions, “what do you see as a benefit to stopping smoking?” Or – give choices, “of these three possibilities, what do you see as one that will work for you?”

8. Motivational Interviewing What you are doing is trying to negotiate with a patient to make a change Through our conversation we need to get the patient to make a commitment to us to make a change – even if it’s a little change or a first step. The is a process Allows the pharmacist to explore the benefits and risks with the patient without judgment

9. Strategies for Motivational Interviewing Opening strategy: lifestyle A Typical Date The good things and the less good things Providing Information The future and the present Helping with the decision-making

10. Principles of Motivational Interviewing Express empathy Develop discrepancy – show how present behavior differs from the desired behavior Avoid argumentation Roll with resistance Support self-efficacy

11. Supportive Communication As we have said before – we are social creatures – we have the need to communicate our feelings Patient adherence is higher when patients are allowed to voice their concerns and anxiety and when physicians took the time to patiently answer patient’s questions Practitioner’s that responded to patients need has higher patient satisfaction and better adherence rates Patient’s who characterized their physician as understanding and caring where more likely to follow their treatment plan

12. Supportive Communication This is not necessarily trying to “make it all better” for the patient What you are doing is – acknowledging their feelings – and confirming what you know to be true Patient: My doctor tells me I have hypertension. Am I going to die?

13. Appropriate Responses Our responses to our patients needs to be motivated by a willingness to help them or care for them Should not come from a need to reduce our anxiety or frustration Our frame of reference should be one of serving the client’s needs not our own

14. Major Focus Helping the patient to: Feel understood and accepted which will also allow them to more openly and freely discuss their problems Achieve a more increased and more accurate understanding of their situation Discuss alternatives where necessary Make decisions about next steps along with specific actions to be taken Make adjustments so that the best results can be obtained

15. Empathy Good for developing a therapeutic relationship Lets the patient know that they are not alone – that they are not “crazy” for what they are feeling Downside: can be painful to go through touch issues or times with the patient – but, working through these painful situation are generally good for the patient

16. Reassurance Its an attempt to make the patient feel better or more confident Good: may be exactly what the patient needs to hear – but make sure they ask for it Downside: runs the risk of appearing to minimize the patient’s feelings Remember each patient is unique and their feelings are unique

17. Probing or Questioning An attempt to gather more information Good: many times more information is required to make a good assessment or draw an appropriate conclusion for the patient Downside: we are getting away from the patient’s feelings – not always helpful

18. Advising Trying to help the patient solve a problem – you have to remember what your realm of expertise is Good: very useful when you are the expert Downside: not so good when the patient is the expert – asking you questions about decisions in their own life

19. Generalizing or Comparing An attempt to state what is generally true Good: may be exactly what the patient wants to hear Downside: once again – may give the appearance that the patient’s feelings are being minimized – are you getting to their unique feelings

20. Assertiveness A response in which there is mutual respect between the patient and the pharmacist Good: no subjective or judgemental responses, allows for differing viewpoints to be awknowledged Downside: sometimes people just want to vent or let loose – the patient is not looking for a reasonable response

21. Aggressiveness This response does not respect the other person’s viewpoint Good: there is no positive here – there may be a temporary feeling of satisfaction – but not good for the therapeutic relationship Downside: if one of the parties are angry, this will allow for the situation to escalate

22. Nonassertiveness In this situation, you fail to respect yourself Good: The other party may get what he or she wants Downside: sets up a potential future situation where you will be taken advantage of

23. Judging Communication where you are telling the patient that they are wrong Good: never good Downside: Not acknowledging the patient’s feelings, may be demeaning

24. Scenario Patient: “Oh sir, (holding up a bottle). I just went out to my car and counted my pills and you shorted me 5 pills again.” Pharmacist: “Mrs. Smith I saw on your record that you had been shorted in the past so I took special care to count your pills two times. I can assure you that the correct amount of pills were in your vial”

25. Scenario Technician: I am so tired of Mr. Jones complaining. He never has a kind word and I can’t stand being around him. Pharmacist: You obviously don’t know how to handle Mr. Jones. Don’t take things so personally. You’re overreacting

26. Questions?