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Communication Strategies. #1 Strategy: Talk, Care and Connect. Create A Favorable Environment. Establish Privacy Reduce Physical Barriers. “Size-Up” the Person’s:. Credibility Health Knowledge Intellect Personality Emotional Status. Determine Beliefs. Cultural influences
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Communication Strategies #1 Strategy: Talk, Care and Connect
Create A Favorable Environment Establish Privacy Reduce Physical Barriers
“Size-Up” the Person’s: • Credibility • Health • Knowledge • Intellect • Personality • Emotional Status
Determine Beliefs • Cultural influences • Beliefs about illness • Value of illness
Recognize and Adapt to Person’s Internal “Noise” • High anxiety persons: • Share overall conclusions first • Low anxiety persons • Build toward conclusion
Employ Positive Non-Verbal Behaviors • Forward lean • Silence—listen • Good eye contact • Warm expression • Postural synchrony • Open posture (uncross arms) • Limit self-adaptors (touching self)
Build a Two-Way Communication Partnership • Adult-Adult: Empowers Choices • Information • Insight • Empathy • Confidence • Parent-Child: Gives Advice • Child-Child: Makes Demands
An Adult Approach…. • “I’m here to help you get the most benefit from your medication.”
Avoid “I-It” Relationships Martin Buber’s Schema… • I-IT • Impersonal; doesn’t acknowledge person • I- You • Businesslike, professional or personal • I-Thou • Empathetic with great understanding
There is No Substitute for Genuine Caring!! • Show real empathy • Personalize the message • Use the patient’s name • Engage them in the conversation • Identify and relate to their needs
Create Credibility • Present a Professional Appearance • Assume a Professional Affect • Establish Trust • Go slow • Follow-through • Display genuine interest • Allow the person to “save face” • Establish Appropriate “Distance” and “Boundaries”
Introverted PharmacistsAchieve Greater Compliance • They are perceived as • More trustworthy • Less overbearing
HelpfulCommunication Factors For Better Adherence Deliver: • Explicit and appropriate instructions • More and clearer information • More and better feedback
Organize the Session • Introduce self and provide a brief orienting statement • Assess the person’s anxiety and beliefs • Prioritize and structure information- giving to span 3-5 main points • Employ transitions between ideas • Closing • Summarize key points • Provide written information, even to the most educated patient
Strategies to Detect Non-Adherence • Gather Objective Data • Refill information and objective lab values • Interview Person • but not via “an inquisition” • Brown-bag Programs • Patients bring all of their medications in a bag to the pharmacist for counseling • Compliance Clinics
Verbal Strategies • Speak Clearly • Avoid jargon • Explain WHY/WHY NOT • Limit message length • Establish 3-5 key messages • Repeat important content
Probe for Understanding • This is an ethical responsibility • “The basic and most common cause of non-compliance is the patient who does not understand that is expected.” Frank E. Young MD Ph.D. Former FDA Commissioner
Strategies to Verify Understanding • Gentle Probes • “What will you do?” “Show me….” • “Why?” • Ask the person to review the content of your counseling • Ask the person to predict the medication’s effects
Provide Information-Pt 1 • Be persuasive! • Describe use • Inform about side effects • Research shows: this does not increase side effects • Tell when and how medication will help • Avoid being too complicated or detailed
Provide Information-Pt 2 • Explain benefits of medication • Raise awareness of body cues • Explain ways person can self-evaluate therapy • Help develop coping mechanisms • Don’t insist that the patient comply
Communicate ViaMultiple Modalities • Speech • Written materials • be alert to non-readers • Graphics • Models • Demos For best results: employ both oral and written presentations
Build Message Redundancy • T1 --Explain what you will tell the patient • T2 -- Tell it • T3 -- Review what you told them
Communicate Frequently • Encourage future communication • Suggest calling to discuss concerns • Refill counseling is an important opportunity to: • Identify changing beliefs about illness • Identify side effects which may lead to non-adherence
Enlist Others • Work with MD to: • Simplify regimen • Reduce number of daily dosage intervals • Adjust to person’s daily routine • Enlist family support
Be Creative • Supply medication reminders • Organizers • Alarms • Check-off sheets • Contracts • Remind of refills by mail or telephone
It’s Not Just About Information… • The lower the patient satisfaction with the interaction, the greater the likelihood of non-adherence • There is no substitute for a warm and caring relationship
Therefore, Provide Both… • Accurate Factual Information • Positive Emotional Aspects
Human Interaction Increases Adherence • Non-adherence was reduced by 25% when the pharmacist, rather than the clerk, handed the medication to the patient. • Patient involvement increases adherence
In closing We have discussed the differences between patient compliance, and patient adherence. The latter is a more complex and inclusive construct. We also considered several reasons why patients do not adhere to treatment regimens, and how healthcare professionals can employ effective communication strategiesto increase patient well-being.