Little known tips you’re not using in your approach to adherence
Getting patients to adhere to treatment in COPD is often easier said than done. At times, treatment may require a different approach. Discover how these little known tips can help you understand your patients on a deeper level and influence adherence at the same time.
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Overcoming the struggle for adherence
Achieving adherence to treatment in COPD can be tricky. When patients are asked why they are nonadherent, they often give practical answers: “My oxygen device is too noisy. Too big. Too uncomfortable. It’s embarrassing to lug around. It limits my ability to live my life.” Even trickier are the answers from patients who may not know how to cope with the reality of their nonadherence: “I’m doing great. I have no complaints and nothing to change.” So what happens when you solve these practical drivers and still find your patient is nonadherent? How can you dig deeper and learn what’s important to them? And, how can you turn their ambivalence toward adherence into an overwhelming air of confidence? We have you covered. Let’s explore some little known tips to treatment that can help you understand your patients on a deeper level and influence adherence in the process.
Contributor
Mark Aloia, PhD
Global Lead, Health Behavior Change Philips HealthTech
Change begins with you
Change is hard. And when you’re asking patients with COPD to change their behavior to bear the burden of therapy, it’s especially hard. It’s easy to talk about what’s relevant to you and focus on your own perspective. But, this often doesn’t help you understand patients on a deeper level or speak to their value system. That’s why it’s important to recognize the need to adapt to their changing needs.
If we want to build confidence in creating change, we need to start with physicians.”
Mark Aloia, PhD
Global Lead, Health Behavior Change Philips HealthTech
Start by empowering yourself to take a personal approach when speaking with patients. Motivational interviewing is an excellent way to to dig deeper and personalize each conversation. With a few simple questions, you can get a stronger sense of the root cause of nonadherence, as well as realistic goals that are actually important to your patients.1
Learn the key steps to motivational interviewing—watch 3 keys to empowering successful self-management.
Another valuable technique you can use is reinforcement. While there are numerous forms of reinforcement, positive reinforcement has been found to help patients improve adherence to treatment.2 Think of your patients who require oxygen therapy. They frequently feel embarrassed to be seen with their oxygen tank in public, leading to nonadherence.2 But, with some positive reinforcement about how therapy will help them meet their personal goals, they may recognize the greater benefits of adherence.2
Use different types of reinforcement for different times in treatment
When initiating behavior change in your patients with COPD, use3
Continuous reinforcement to build confidence in the desired change
Intermittent reinforcement to maintain confidence in the new behavior over time
Patients want to feel understood. They want to know you have their best interest in mind and feel confident that they can achieve adherence to treatment. So how can you relate to them on a personal level and put yourself in their shoes? Try active listening and empathy.
If we want to build confidence in creating change, we need to start with physicians.”
Mark Aloia, PhD
Global Lead, Health Behavior Change Philips HealthTech
Active listening has been shown to improve4:
Improve your active listening skills with these tips5:
Restate what your patient is saying to show you are listening Summarize the problems they’re experiencing to make sure you’re fully understanding what they are telling you Encourage them to keep speaking with brief positive prompts such as, “I understand” Validate their problems, issues and feelings by responding with empathy
Use the PAUSE method
PAUSE may be a valuable technique when listening and speaking with your patients: Personalization—understand what their personal goals are and tie in a behavior that helps them meet their goals Autonomy—adherence is a personal choice that must be made by each patient alone. While you can emphasize the value of it, don’t push too hard. Focus rather on guiding your patients and helping them take ownership over their own choices Urgency—create a sense of urgency to adherence based on their value system Social support—suggest groups that your patient can join that will help reinforce adherence to treatment Empowerment—build confidence in your patient by setting reachable goals and highlight their success each time they achieve one
To create urgency, it’s important to know when to take your foot off the gas, because when we do that patients tend to put their foot on it and take ownership.”
Mark Aloia, PhD
Global Lead, Health Behavior Change Philips HealthTech
Leverage their support system6 How can we better support caregivers in COPD interventions?
The reality is, you may only get to see your patients a few times a year. This gives you a small window to reinforce adherence and help them meet their goals. Although your time is limited, there may be another way to help maximize their chances of adherence. It involves talking to the people who are with them the most: their family. Family members need to be approached and taught the right way to help with adherence. If not, their dialogue can come across as nagging or belittling, which can be counterproductive to adherence.
Ask your patient if they would welcome their family helping them out with treatment.
With their approval, set aside time to meet with their family.
Open the dialogue and identify how they can be most supportive of your patient.
Teach them techniques to reinforce adherence and motivate your patient at home. This can be anything from active listening skills to motivational interviewing tactics.
Adherence is a lifelong process
Getting patients with COPD to adhere to treatment doesn’t happen overnight. And, at times it may seem like quite the uphill battle. But, there’s hope. By strengthening your ability to change, actively listening and enlisting the help of a support system, adherence may become a constant in your patient’s life. And your goal of keeping patients healthy at home is one step closer.
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Further reading
References: 1. Sperry L. Motivational interviewing, nonadherence to medical treatment, and families. Fam J Couns Ther Couples Fam. 2012;20(3):306-308. 2. Bourbeau J, Bartlett SJ. Patient adherence in COPD. Thorax. 2008;63(9):831-838. 3. Decramer M, Nici L, Nardini S, et al. Targeting the COPD exacerbation. Respir Med. 2008;102 (Suppl 1):S3-S15. 4. Jahromi VK, Tabatabaee SS, Abdar ZE, Rajabi M. Active listening: the key of successful communication in hospital managers. Electron Physician. 2016;8(3):2123-2128. 5. Grohol J. Become a Better Listener: Active Listening. PsychCentral Web site. https://psychcentral.com/lib/become-a-better-listener-active-listening/. Published May 17, 2016. Accessed June 2, 2017. 6. Bryant J, Mansfield E, Boyes AW, Waller A, Sanson-Fisher R, Regan T. Involvement of informal caregivers in supporting patients with COPD: a review of intervention studies. Int J Chron Obstruct Pulmon Dis. 2016;11:1587-1596. https://www.qualitymeasures.ahrq.gov/summaries/summary/49195/chronic-obstructive-pulmonary-disease-copd-hospital-30day-allcause-riskstandardized-readmission-rate-following-acute-exacerbation-of-copd-hospitalization. Published October 1, 2015. Accessed June 1, 2017.
