opportunities for lifestyle change using "the teachable moment"
TRANSCRIPT
OPPORTUNITIES FOR LIFESTYLE CHANGE USING “THE TEACHABLE MOMENT” - A PROOF OF CONCEPT PILOT IN THE UROLOGY SERVICE
Dr Alyssa Lee, Health Psychologist
Mr Steve Leung, Consultant Urological Surgeon
Background
Funding from Detect Cancer Early - proposal highlighted the Urology site as for a proof of concept pilot
Collaborative project to introduce a Health Psychologist into the Urology team to capitalise on the ‘teachable moment’ for behavioural change
Increasingly utilise ‘teachable moments’ to improve patient outcomes through timely, evidence-based interventions in testing, screening and treatment for cancer
Why this work is needed
Fits with health promoting health service and priority to improve cancer services
Many cancers can be prevented through lifestyle change 1
Patients in secondary care are likely to have risk factors for other cause of mortality/morbidity 2
1. Parkin et al, 2010; World Cancer Research Fund, 20142. Schmitz et al, 2010
Why this work is needed
In absence of lifestyle change advice and support negative tests/screens could be seen as endorsing current behaviour ‘health certificate effect’ 1
Improved symptom management and quality of life can accompany and follow lifestyle change 2
Can play a significant role in cancer reoccurrence, staging and cancer survival rates 3
1. Larsen et al, 2007 in Anderson 20142. Demark-Wahnefried et al., 20053. Moreira et al, 2013
What is a ‘teachable moment’?
1. an opportunity arising between a ‘patient’ and ‘health professional’ during consultations to mention and encourage change.
2. a specific event/context, which can predictably be associated with an increased desire, willingness or capacity for change in patients
3. a cueing event in which an individuals’ perceptions change and make them more favourable for change.
Teachable moments interventions
Risk communication e.g. Endorsement of importance of lifestyle change by credible source like a nurse/doctor
Motivational approaches e.g. Raise intention to change through motivational interviewing, exploration of pro/cons, ambivalence, values for health etc.
Implementation approaches e.g. Develop action plans for change, signpost to relevant services, introduce self-monitoring aids etc.
What is notable, and supported by the wider behaviour change
literature is that all of the above require a supportive system to
be effectively utilised to increase motivation, and to
enact change.
Progress
What have we done so far...
Setting up of the service
Identifying where TM interventions can be implemented Review of clinical pathways for cancer
patients Observation of consultant and nurse-led
clinics
Developing materials to identify lifestyle behaviours Flyer and lifestyle survey collaboratively
developed and piloted for routine TRUS clinic
Baseline assessment of behaviours started
Setting up of the service
What does the service look like? Focusing on patients with a negative results
following biopsy of the prostate
Clinics for one-to-one consultations
Close relationship with cancer nurse specialists
Generating clinic letters to GPs
Looking at supporting men on active surveillance
Prospectively auditing the service
Delivering the service
Developing a culture to effectively utilise “TMs”: Staff survey: motivation, intention, skills to discuss
lifestyle change
Raising awareness of TM opportunities with staff
Support and training in communication approaches and behaviour change techniques
Clinical case study presentation at unit meetings
Inclusion of lifestyle factors in follow up reviews
Other cancer areas
Could this approach be more widely implemented in cancer services?
Lessons learned will provide valuable insight into opportunities in other secondary care cancer settings
But...approach likely depend on contextual factors in each cancer service
Key messages
TM work is implementable at this early stage
Identifying a large cohort with both negative and positive results
CNS support is pivotal to the work
Requires buy-in from other staff to reinforce messages
