Helping Patients Change Flashcards
(29 cards)
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
