2 nd Module: Communication Skills for Healthcare Professionals

1. 2nd Module: Communication Skills for Healthcare Professionals “A European network on cervical cancer surveillance and control in the new Member States - AURORA”

2. Partner www.aurora-project.eu This publication arises from the project «AURORA» which has received funding from the European Union in the Framework of the Health Programme.

3. Index Effective Communication skills for Health Care Professionals Communicating for Health Doctor – Patient relations in preventive care A doctor’s Issue The basic rule to know What to do How to speak? Explain the preventive nature of the Papanicolaou test Changing Health Habits Changing poor health habits Attitudinal approaches to health behavior change Educational Appeals Fear Appeals Why do people change? Interview Principles Learn your facts and think of your responses Health Psychologists Summary References

4. Effective Communication skills for Health Care Professionals Effective Communication skills for Health Care Professionals

5. Summary Interview D-P relations Yes..but How to speak? Health habits Communicating for Health • Doctor – Patient relations in preventive care • Yes, but… dilemma • How to speak with patients • Changing Health Habits • Motivational Interview • Why do people change? • Example: Doctor-Patient dialog • Summary Adherence to and understanding of medical instructions very much depend on the ability of the Health Care Professional to communicate effectively with their patient.

6. Summary Interview D-P relations Yes..but How to speak? Health habits Doctor – Patient relations in preventive care The first visit for a patient is crucial and can lead to either the start of an effective relationship or end in dissatisfaction on both sides and the search for another care provider or the refusal of engaging in the preventive activity (i.e. Pap test).

7. Summary Interview D-P relations Yes..but How to speak? Health habits A doctor’s Issue Doctor – Patient communication includes verbal and non-verbal processes through which a doctor obtains and shares information with a patient, thereby developing a therapeutic relationship. Communication may seem simple. In reality this type of communication can prove rather challenging.

8. Summary Interview D-P relations Yes..but How to speak? Health habits A doctor’s Issue

9. Summary Interview D-P relations Yes..but How to speak? Health habits The basic rule to know Especially when it comes to preventive care. What a doctor should learn to recognize first is the: YES …BUT…DILLEMA

10. Summary Interview D-P relations Yes..but How to speak? Health habits Yes …but…dillema When people want to change, and at the same time don’t want to change. When they would like to have a Pap test …but at the same time issues such as embarrassment, lack of knowledge, cultural and religious barriers stops them. Pap test….?

11. Summary Interview D-P relations Yes..but How to speak? Health habits Yes …but…dillema Exploring ambivalence is working at the heart of the problem of being stuck This is referred to as: ambivalent conflict and Resolving ambivalence is crucial in order for change to occur. Dealing with ambivalent thoughts will enable a person to make valuable decisions moving on toward change

12. Summary Interview D-P relations Yes..but How to speak? Health habits What to do Make eye contact with the patient, shake hands, and introduce yourself Set the patient at ease and build rapport Avoid judgmental language or behaviors Don’t stand Provide Encouragement Let the patient tell their story Use open-ended questions Build Partnership – this will encourage your patient to come back for a follow up test Don’t assume people know medicine – explain- use examples Be aware of your non-verbal cues –don’t show irritation, disapproval, impatience Learn about the patient’s background (religious or cultural barriers) Encourage them to ask questions Pay attention to the clues, both verbal and non-verbal

13. Summary Interview D-P relations Yes..but How to speak? Health habits How to speak? I want to have a Pap test ….but I am embarrassed to do so.. Don’t Don’t be embarrassed I see many women every day! Women especially those from marginalized groups like migrants may have cultural and religious barriers to having a male doctor examine them

14. Summary Interview D-P relations Yes..but How to speak? Health habits How to speak? Say instead ;) I understand your feelings – but lets talk about what a Pap test is – in what way it will benefit your health Would you prefer that a female nurse conducts the Pap test?

15. Summary Interview D-P relations Yes..but How to speak? Health habits How to speak? “Because its good for your health” or “because it will save you from cancer” Don’t I feel fine why should I have a Pap test Many women are afraid even of hearing the word cancer. Many women especially from developed countries believe that since one feels fine there is nothing wrong with them.

16. Summary Interview D-P relations Yes..but How to speak? Health habits Explain the preventive nature of the Papanicolaou test Say instead

17. Summary Interview D-P relations Yes..but How to speak? Health habits Explain the preventive nature of the Papanicolaou test Say instead Some diseases develop over a very long period – when you look after yourself by having frequent test you save yourself money and problems for the future back

18. Summary Interview D-P relations Yes..but How to speak? Health habits Explain the preventive nature of the Papanicolaou test Say instead It prevents precancerous lesions way before they become cancer back

19. Summary Interview D-P relations Yes..but How to speak? Health habits Don’t Don’t I am afraid of cancer…I don’t want to know if I have cancer I understand that you are scared but it is not as terrible as you think

20. Summary Interview D-P relations Yes..but How to speak? Health habits Say instead Say instead Use simple but accurate information about the preventive nature of the Pap test Don’t assume all women understand medical terminology Be reassuring and understanding no matter how simple the questions may be

21. Summary Interview D-P relations Yes..but How to speak? Health habits Explain Explain Many doctors don’t provide adequate information about cervical cancer and don’t emphasize the preventive characteristics of the test

22. Summary Interview D-P relations Yes..but How to speak? Health habits Don’t Don’t I don’t want to find out that I have HPV, my partner will be angry at me, I will be in trouble

23. Summary Interview D-P relations Yes..but How to speak? Health habits Don’t Don’t Many doctors avoid interfering at this point allowing for misconceptions to emerge HPV is largely either not understoodor misunderstood because of its connection to sex as the main way of transmission

24. Summary Interview D-P relations Yes..but How to speak? Health habits Instead Instead Explain what the virus is; How the majority of women are infected; How asymptomatic the virus is over many years; How most women who have HPV will never get cancer; Provide educational material;

25. Summary Interview D-P relations Yes..but How to speak? Health habits Changing Health Habits “Habit is habit, and not to be flung out of the window by any man, but coaxed downstairs a step at a time” Mark Twain

26. Summary Interview D-P relations Yes..but How to speak? Health habits Changing poor health habits Attitudinal approaches to health behavior change Educational Appeals Fear Appeals

27. Summary Interview D-P relations Yes..but How to speak? Health habits Attitudinal approaches to health behavior change • Provide people with correct information about the implications of their poor health habits • May be motivated to change those habits in a healthy direction • Attitude change campaigns • •Induce the desire • •Not successful when simply ‘teaching’ people exactly how to do so

28. Summary Interview D-P relations Yes..but How to speak? Health habits Educational Appeals Messages should state conclusions explicitly •A communication praising the virtues of cervical cancer screening should explicitly conclude that the person should alter her behavior to include screening More extreme messages produce more attitude change but only up to a point •Very extreme messages are discounted For illness detection behaviors, such as cervical cancer screening, emphasizing the problems that may occur if it is not undertaken will be most effective •For health promotion behaviors , such as sunscreen use , emphasizing the benefits to be gained may be more effective

29. Summary Interview D-P relations Yes..but How to speak? Health habits Educational Appeals If the audience is receptive to changing a health habit, then the communication should include only favorable points •If the audience is not inclined to accept the message, the communication should discuss both sides of the issue For example: •People ready to do the cervical cancer screening should be told only of the health benefits of the screening •People who have not yet decided to do the cervical cancer screening may be more persuaded by a communication that points out the risk of not doing the screening while acknowledging and challenge its avoidance

30. Summary Interview D-P relations Yes..but How to speak? Health habits Educational Appeals Providing information Does not ensure that people will receive information accurately When people receive negative information about risks of their health •They process that information defensively •Instead of making appropriate health behavior changes , the person may come to view the problem as less serious or more common than she had previously believed

31. Summary Interview D-P relations Yes..but How to speak? Health habits Fear Appeals Assumes: If people are fearful that a particular habit is hurting their health, they will change their behavior to reduce the fear •The more fearful an individual is, the more likely she will be to change the relevant behavior •Research has found that this relationship does not always hold Change it or not..?

32. Summary Interview D-P relations Yes..but How to speak? Health habits Fear Appeals • Persuasive messages that elicit too much fear may actually undermine health behavior change • •Fear alone: • •May not be sufficient to change behavior • •May not produce long lasting changes in health habits • Unless fear it is coupled with: • •Recommendations for action • •Information about the efficacy of the health behavior

33. Summary Interview D-P relations Yes..but How to speak? Health habits Why do people change? Interest in the topic of patient’s motivation often begins with wondering why women donot want to participate in Pap test. But more productive and useful question is why women want to take care of their health. According to Miller and Rollnic (2002) three components of motivation are: • Willingness to change • Ability to do it • Readiness

34. Summary Interview D-P relations Yes..but How to speak? Health habits The importance of change Willingness: The Importance of Change People want to change their behavior when there is a high degree of discrepancy between what is happening at present and what one values for the future. First of all, doctor should develop this discrepancy in his patients.

35. Summary Interview D-P relations Yes..but How to speak? Health habits Confidence for Change Ability: Confidence for Change In this part of the conversation doctor should provide a solution. Sometimes women feel willing but not able to take care of their health.

36. Summary Interview D-P relations Yes..but How to speak? Health habits A Matter of Priorities Readiness: A Matter of Priorities I don’t want to have cervical cancer, but Pap test is not the most important thing right now. Women can be willing and able to take care of their health, but not ready to do it.

37. Summary Interview D-P relations Yes..but How to speak? Health habits Interview What do you know about cervical cancer? I heard something about it... Doctor begins with an open question

38. Summary Interview D-P relations Yes..but How to speak? Health habits Interview Do you know that you can prevent its occurrence? What should I do?

39. Summary Interview D-P relations Yes..but How to speak? Health habits Interview You have to perform Pap test regularly I know but it will be a problem for me The client immediately expresses ambivalence that could easily be understood as defensiveness

40. Summary Interview D-P relations Yes..but How to speak? Health habits Interview Why will it be a problem for you? I will be ashamed a little bit I understand that such an examination isn’t a pleasure for women. No, it isn’t Instead of confronting, the doctor uses simple reflection The doctor assumes that there is continuing ambivalence, and uses this opportunity to reinforce motivation by looking ahead I don’t know, but I hope that I will be healthy Reflection and reinforcing an important value What do you think might happen if you don’t participate in Pap test examination? I wish, it would be true, but I think that you can reassure yourself by taking care of your health for example - making Pap test

41. Summary Interview D-P relations Yes..but How to speak? Health habits Interview Instead of confronting, the doctor uses simple reflection D: Why will it be a problem for you? P: I don’t have time for it. D: I know that participating in cervical cancer screening will take your time. P: I have work, children, I really don’t have time D: So if you don’t participate in this program you will save your time P: Yes, of course! D: So, what do you think might happen if you have some abnormal changes in your cervix? P: I hope that I don’t have any. D: I wish you didn’t but if it happens, how much time will you waste? P: You are right. Curing will take much more time, and then I couldn’t go to work D: What other problems could you have then? P: I will not have anybody who will take care of my child... D: Isn’t it true that wasting one hour for Pap test will let you save many days? P: You are right. Simple affirmation The doctor assumes that there is continuing ambivalence, and uses this opportunity to reinforce motivation by looking ahead The doctor uses reflection and continues looking ahead Asking for elaboration Doctor uses suggesting question

42. Summary Interview D-P relations Yes..but How to speak? Health habits Interview How may this Pap test help me? If I have cancer - I have it, and nothing can change it. This examination may detect cervix abnormalities, which may lead to cervical cancer. If we find out that you are in an early stage of such abnormalities, we can prevent cervical cancer. Giving the information

43. Summary Interview D-P relations Yes..but How to speak? Health habits Principles collaboration - avoiding an authoritative attitude, instead of communicating a partner-like relationship asking questions more than making statements Client rather than the doctor should present the arguments for the change support rather than persuasion exploration more than exhortation

44. Summary Interview D-P relations Yes..but How to speak? Health habits Learn your facts and think of your responses Be aware of language barriers and try to use an interpreter; When working with women from marginalized groups: If you are male know of a female colleague that can perform the Pap smear Explain what the Pap test does What cervical cancer is What the role of HPV is Be matter-of-fact and non-judgmental when explaining HPV and its connection to cervical cancer. Talk about how common HPV is. Explain how almost all women will get the virus, but few will develop cervical cancer. Acknowledging specific cultural beliefs Acknowledge shame, fear and embarrassment;

45. Summary Interview D-P relations Yes..but How to speak? Health habits Health Psychologists Developed approaches to health habit change that integrate: • Educational factors • Motivational factors Examining: • Perceptions of susceptibility to a health risk • Beliefs about the importance of health habits for meeting those risks • Perception of personal ability to offset those risks

46. The degree to which the particular health measure advocated is effective, desirable and easy to implement The desire to which that person believes she can perform the response necessary to reduce the threat (self-efficacy) The degree to which that person believes she is personally vulnerable to that threat The magnitude of a health threat Summary Interview D-P relations Yes..but How to speak? Health habits Summary Whether a person practices a particular health behavior depends on several beliefs and attitudes: All photos licensed by FreeDigitalPhotos.net Ambro, Stewart Miles, Castillo Domonici, Andy Newson, photostock

47. Summary Interview D-P relations Yes..but How to speak? Health habits Doctor –Patient communication includes verbal and non-verbal processes. true false Many doctors don’t provide adequate information about cervical cancer and don’t emphasize the preventive characteristics of the test true false References: click here

48. Summary Interview D-P relations Yes..but How to speak? Health habits Very good

49. Summary Interview D-P relations Yes..but How to speak? Health habits You haven’t learned much!

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