2 nd Module: Communication Skills for Healthcare Professionals
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Transcript of 2 nd Module: Communication Skills for Healthcare Professionals
“A European network on cervical cancer surveillance and control in the new Member States - AURORA”
2nd Module: Communication Skills for Healthcare Professionals
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.
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Effective Communication skills for Health Care ProfessionalsCommunicating for Health Doctor – Patient relations in preventive careA doctor’s Issue The basic rule to know What to do How to speak?Explain the preventive nature of the Papanicolaou testChanging Health HabitsChanging poor health habitsAttitudinal approaches to health behavior changeEducational AppealsFear AppealsWhy do people change?InterviewPrinciplesLearn your facts and think of your responses Health PsychologistsSummaryReferences
Index
Effective Communication skills for Health Care Professionals
Effective Communication skills for Health Care Professionals
Doctor – Patient relations in preventive care Doctor – Patient relations in preventive care
Yes, but… dilemmaYes, but… dilemma
How to speak with patientsHow to speak with patients
Changing Health HabitsChanging Health Habits
Motivational InterviewMotivational Interview
o Why do people change?Why do people change?
o Example: Doctor-Patient dialogExample: Doctor-Patient dialog
SummarySummary
D-P relations Yes..but How to speak? Health habits Interview Summary
Communicating for Health
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).
D-P relations How to speak? Health habits Interview Summary Yes..but
Doctor – Patient relations in preventive care
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.
D-P relations How to speak? Health habits Interview Summary Yes..but
A doctor’s Issue
A doctor’s Issue
D-P relations How to speak? Health habits Interview Summary Yes..but
Especially when it comes to preventive care.
What a doctor should learn to recognize first is the:
D-P relations How to speak? Health habits Interview Summary Yes..but
The basic rule to know
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….?
D-P relations How to speak? Health habits Interview Summary Yes..but
Yes …but…dillema
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
Exploring ambivalence is working at the
heart of the problem of being stuck
D-P relations How to speak? Health habits Interview Summary Yes..but
Yes …but…dillema
Make eye contact with the patient, shake hands, and introduce yourselfSet the patient at ease and build rapport
Don’t stand
Let the patient tell their storyUse open-ended questions
Don’t assume people know medicine – explain- use examples
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
Avoid judgmental language or behaviors
Provide Encouragement
Build Partnership – this will encourage your patient to come back for a follow up test
Be aware of your non-verbal cues –don’t show irritation, disapproval, impatience
D-P relations How to speak? Health habits Interview Summary Yes..but
What to do
Don’t Don’t I want to have a Pap test ….but I
am embarrassed to
do so..
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
D-P relations How to speak? Health habits Interview Summary Yes..but
How to speak?
I understand your feelings – but lets talk about what a Pap test is – in what way it will
benefit your health
Say instead Say instead
Would you prefer that a female nurse
conducts the Pap test?
;)
D-P relations How to speak? Health habits Interview Summary Yes..but
How to speak?
Don’t Don’t
“Because its good for your health”
or “because it will save you from
cancer”
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.
I feel fine why should I have a Pap test
D-P relations How to speak? Health habits Interview Summary Yes..but
How to speak?
Say instead Say instead
D-P relations How to speak? Health habits Interview Summary Yes..but
Explain the preventive nature of the Papanicolaou test
Say instead 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
D-P relations How to speak? Health habits Interview Summary Yes..but
Explain the preventive nature of the Papanicolaou test
It prevents precancerous
lesions way before they become
cancer
Say instead Say instead
back
D-P relations How to speak? Health habits Interview Summary Yes..but
Explain the preventive nature of the Papanicolaou test
I am afraid of cancer…I don’t
want to know if I have cancer
Don’t Don’t
I understand that you are scared but it is not as terrible
as you think
D-P relations How to speak? Health habits Interview Summary Yes..but
Don’t
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
Say iSay instead nstead
D-P relations How to speak? Health habits Interview Summary Yes..but
Say instead
D-P relations How to speak? Health habits Interview Summary Yes..but
ExplainExplainExplain
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
D-P relations How to speak? Health habits Interview Summary Yes..but
Don’t
HPV is largely either not understood or
misunderstood because of its connection to sex
as the main way of transmission
Don’t Don’t
Many doctors avoid interfering at this point allowing for misconceptions to
emerge
D-P relations How to speak? Health habits Interview Summary Yes..but
Don’t
IInstead nstead
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;
D-P relations How to speak? Health habits Interview Summary Yes..but
Instead
“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
D-P relations
How to speak?
Health habits
Interview
Summary Yes..but
Changing Health Habits
Attitudinal approaches to health behavior change
Educational Appeals
Fear Appeals
D-P relations How to speak? Health habits Interview Summary Yes..but
Changing poor health habits
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
D-P relations How to speak? Health habits Interview Summary Yes..but
Attitudinal approaches to health behavior change
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
D-P relations How to speak? Health habits Interview Summary Yes..but
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
D-P relations How to speak? Health habits Interview Summary Yes..but
Educational Appeals
Providing informationDoes not ensure that people will receive information accuratelyWhen 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
D-P relations How to speak? Health habits Interview Summary Yes..but
Educational 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..?
D-P relations How to speak? Health habits Interview Summary Yes..but
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
D-P relations How to speak? Health habits Interview Summary Yes..but
Fear Appeals
Why do people change?
Interest in the topic of patient’s motivation often begins with wondering why women do not 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
D-P relations How to speak? Health habits Interview Summary Yes..but
Willingness: The Importance of Change
D-P relations How to speak? Health habits Interview Summary Yes..but
The importance of change
Ability: Confidence for Change
Sometimes women feel willing but not able to
take care of their health.
In this part of the conversation doctor
should provide a solution.
D-P relations How to speak? Health habits Interview Summary Yes..but
Confidence for Change
Readiness: A Matter of Priorities
D-P relations How to speak? Health habits Interview Summary
Women can be willing and able to take care of their health, but not ready to do it.
I don’t want to have cervical cancer, but Pap test is not the
most important thing right now.
Yes..but
A Matter of Priorities
What do you know about
cervical cancer?
I heard something about it...
Doctor begins with an open questionDoctor begins with an open question
D-P relations How to speak? Health habits Interview Summary Yes..but
Interview
Do you know that you can prevent its
occurrence?
What should I do?
D-P relations How to speak? Health habits Interview Summary Yes..but
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
D-P relations How to speak? Health habits Interview Summary Yes..but
Interview
Why will it be a
problem for you?I will be ashamed a little bit
Instead of
confronting, the
doctor uses
simple reflection
I understand that such an
examination isn’t a pleasure for
women.
No, it isn’t
I don’t know, but I hope
that I will be healthy
Reflection and
reinforcing an
important value 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
The doctor assumes that there is continuing
ambivalence, and uses this opportunity to
reinforce motivation by looking ahead
What do you think might happen if you don’t participate in
Pap test examination?
D-P relations How to speak? Health habits Interview Summary Yes..but
Interview
DD: Why will it be a problem for you?P: I don’t have time for it.DD: I know that participating in cervical cancer screening will take your time.P: I have work, children, I really don’t have timeDD: So if you don’t participate in this program you will save your timeP: Yes, of course!DD: 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. DD: 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 workDD: What other problems could you have then?P: I will not have anybody who will take care of my child...D: D: Isn’t it true that wasting one hour for Pap test will let you save many days?P: You are right.
Simple affirmation
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
The doctor uses reflection and continues looking ahead
Asking for elaboration
Doctor uses suggesting question
D-P relations How to speak? Health habits Interview Summary Yes..but
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
D-P relations How to speak? Health habits Interview Summary Yes..but
Interview
collaboration - avoiding an authoritative attitude, instead of communicating a partner-
like relationship
asking questions more than making statements
exploration more than exhortation
support rather than persuasion
Client rather than the doctor should present the arguments for the change
D-P relations How to speak? Health habits Interview Summary Yes..but
Principles
When working with women from marginalized groups:
Be aware of language barriers and try to use an
interpreter;
If you are male know of a female colleague that can
perform the Pap smearExplain what
the Pap test doesWhat 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;
D-P relations How to speak? Health habits Interview Summary Yes..but
Learn your facts and think of your responses
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
D-P relations
How to speak?
Health habits
Interview
Summary Yes..but
Health Psychologists
Whether a person practices a particular health behavior depends on several beliefs and attitudes:
The magnitude of a health threat
D-P relations
How to speak?
Health habits
Interview
Summary
All photos licensed by FreeDigitalPhotos.netAmbro, Stewart Miles, Castillo Domonici, Andy Newson, photostock
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Summary
D-P relations How to speak? Health habits Interview Summary
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true
false
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References: click here
D-P relations How to speak? Health habits Interview Summary
Very goodVery good
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D-P relations How to speak? Health habits Interview Summary
You havenYou haven’’t t learned much!learned much!
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References• Banks, SM., Salovey, P., Greener, S., Rothman, A.J., Moyer, A., Beauvais, J., & Spel, E. ( 1995). The effects of message framing on mammography utilization. Health Psychology,
14, 178-184.• Barry D. Weiss. Health literacy and patient safety: Help patients understand. Manual for clinicians. Second edition2007 American Medical Association Foundation and
American Medical Association.• Becker, M.H. & Janz, N.K. (1987). On the effectiveness and utility of health hazard/health risk appraisal in clinical and nonclinical settings. Health Services Research, 22, 537-
551.• Carlson, N.R. (1998). Psychology of behavior. Boston: Allyn & Bacon.• Conner, M. & Norman, P. (1995). Predicting health behavior: Research and practice with social cognition models. Buckingham, Philadelphia: Open University Press.• Croyle , R.T., Sun, Y. C., & Louie, D. H. ( 1993). Psychological minimization of cholesterol test results: Moderators of appraisal in college students and community residents.
Health Psychology, 12, 503-507.• Gerrard, M., Gibbons, F. X., Benthin, A. C., & Hessling, R. M. (1996). A longititudinal study of the reciprocal nature of risk behaviors and cognitions in adolescents: What you do
shapes what you think, and vice versa. Health Psychology, 15, 344-345.• Kalichman, S. C., & Coley, B. (1996). Context framing to enhance HIV- antibody-testing messages targeted to African American women. Health Psychology, 14, 247-254.• Leventhal, H. (1970). Findings and theory in the study of fear communications. In L. Berkowitz (Ed.), Advances in experimental social psychology (Vol. 5, pp. 120-186). New
York: Academic Press. • Millar, M. G., & Millar, K. (1995). Negative affective consequences of thinking about disease detections behaviors. Health Psychology, 14, 141- 146.• Millar, M. G., & Millar, K. (1996). The effects of anxiety on response times to disease detection and health promotion behaviors. Journal of Behavioral Medicine, 19, 401- 414.• Miller, W.R., Rollnick, S. (2002). Motivational Interviewing. Preparing People for Change. New York, London: The Guilford Press.• Norman, P., Abraham, C. & Conner, M. (2000). Understanding and Changing Health Behavior: From Health Beliefs to Self-Regulation. Australia: Hardwood academic
publishers.• Ogden, J. (2003). Health Psychology: A textbook (2nd Eds). Buckingham: Open University Press.• Rothman, A.J., & Salovey, P. (1997). Shaping perceptions to motivate healthy behavior: The role of message framing. Psychological Bulletin, 121, 3-19• Rutter, D. & Quine, L. (2002). Changing Health Behavior. Buckingham: Open University Press.• S.E. Taylor & Thompson, S.C. (1982). Stalking the elusive ‘vividness’ effect. Psychological Review, 89, 155-181.• Savard, M. Bridging the Communication Gap between Practitioners and their Patients. Role of HPV and Advances in Cervical Cancer Prevention in Monsonego J. (ED.)
Emerging Issues on HPV Infections from Science to Practice, Basel: Karger Publications, 2006. • Self, C. A., & Rogers, R.W. (1990). Coping with threats to health: Effects of persuasive appeals on depressed, normal, and antisocial personalities. Journal of Behavioral
Medicine, 13. 343-358.• Stroebe, W. & Stroebe, M., S. (1997). Social Psychology and Health. Great Britain: St Edmundsbury Press.• Sturges, J. W., & Rogers, R.W. (1996). Preventive health psychology from a developmental perspective: An extension of protection motivation theory. Health Psychology, 15,
158-166.• Sutton, S. R., & Eiser, J. R. (1984). The effect of fear-arousing communications on cigarette smoking: An expectancy-value approach. Journal of Behavioral Medicine, 7, 13-34.• Weinstein, N.D. (1993). Testing four competing theories of health-protective behavior. Health Psychology, 12, 324-333.