Why does communication and consultation style matter

Dr Catherine Hood

Goals of this session

• This session is at the core of the Academy

• It will cover the following learning modules:

• Patient profiling• Communication style• Treatment information and patient expectations

• Each module will include a variety of interactive exercises to improve your learning experience

• Remember, this is not just about improving your own skills – we want to equip you to teach others

There are real benefits to treatment adherence

•Happy patients

• Satisfied HCPs

•Benefits are scientific, economic and personal

Self-confidence

Day-to-day living

Workplace productivity

Employment opportunities

Social activities

Relationships

Sexual functionThe effects of psoriasis are far-reaching and frequently affect the patient’s physical, social and psychological well-being1

Psoriasis impacts all aspects of the patient’s life1–3

1. Feldman. Cutis 2013;92:258–263; 2. Bewley et al. J Eur Acad Dermatol Venereol 2014;28:763–770; 3. Richards et al. J Eur Acad Dermatol Venereol 2006;20:370–379

Topical treatment adherence is generally perceived as poor

• Topicals can be associated with high burden of treatment due to inconvenience of administration2

• The necessity of topical application exacerbates non-adherence3

• At least one-third (39–73%) of patients with psoriasis do not use their medication as prescribed4

• Cosmetic acceptability and ease-of-use of the topical preparation affects patient preference and adherence5

1. Feldman et al. J Am Acad Dermatol 2008;59:1009–1016; 2. Zschocke et al. J Eur Acad Dermatol Venereol 2014;28:4–9;

3. Daudén et al. J Eur Acad Dermatol Venereol 2014;28(Suppl 2):22–32; 4. Bewley et al. J Eur Acad Dermatol Venereol 2011;25:9–14;

5. Bewley et al. J Eur Acad Dermatol Venereol 2014;28:763–770

‘There is one vehicle that is the best one to prescribe for a patient with psoriasis: the vehicle that a patient will use’1

Inte

rvention

Solving the problem of non-adherence to topical psoriasis treatment1

1. Brown et al. J Am Acad Dermatol 2006;55:607–613; 2. ClinicalTrials.gov. http://clinicaltrials.gov/ct2/show/study/NCT01587755;

3. Reich et al. Arch Dermatol Res 2014;306:667–676

Little influenceOptimal and efficacious treatment Educational intervention

Intrinsic reasons Quality of medicationHCP and patient communication

Disease activity Treatment not effective Unclear instructions

Quality of life impairment Medication stained clothes and surfaces Directions too complicated

Physical limitationprevented use

Application was time-consuming Forgot/lost HCP’s instructions

Gender Interfered with daily activities Fear of potential side effects

Medication felt unpleasant

Developed side effects

Communication challenges

• Chronic disease

• Visible

• Wide variety of patient responses

• Frequency of interaction with HCPs

• Long-term condition requiring patients to self-care

• Converting patient passivity to active engagement

• Ability to adapt consultation style

Physician communication styles

Roter et al. JAMA 1997;277:350–356

Biopsycho-social

Psycho-socialBiomedical

Physician-directed Person-centred

An estimated 75% of physicians employ a physician-directed communication style

Patient communication styles

• Patients vary in their communication style too

• Some are passive and others more active participants

• Patients want different levels of engagement and involvement when it comes to decisions about treatment

• An individual’s desire for information is not static but can change during their course of treatment

What is person-centred communication?

• ‘Respecting and responding to patients’ wants, needs and preferences, so that patients can make choices in their care that best fit their individual circumstances’1

• Studies demonstrate that person-centred care is associated with improved healthcare outcomes, particularly in patients with chronic diseases2

1. Institute of Medicine (US). Committee on Quality of Health Care in America. National Academy Press, 2001

2. Epstein, Street. National Cancer Institute, NIH, 2007

Evidence that person-centred communication works

• Substantial amount of evidence demonstrates that person-centred communication has a positive effect on important outcomes, including patient satisfaction, adherence, and self-management of chronic disease1

• Person-centred communication has been found to correlate with patients’ perceptions of finding common ground (shared goals)2

• Positive perceptions were associated with better recovery from discomfort and concern, better emotional health, and fewer diagnostic tests and referrals

• Attributes related to person-centred communication have been found to be associated with a greater likelihood of patients reporting high-quality care3

• For additional information see: http://www.sgkpa.org.uk/images/newsletters/Measuring_what_really_matters.pdfhttp://www.each.eu/wp-content/uploads/2014/07/tEACH-Models-of-the-consultation_0.pdf

1. Levinson et al. Health Affairs 2010;29:1310–1317; 2. Stewart et al. J Fam Pract 2000;49:796–804;

3. Lebrun-Harris et al. Ann Fam Med 2013;11:508–516

Goals of this programme

• Introduce person-centred communication:

• Models of a person-centred consultation, including the two-agenda model for communication

• The evidence for its use in improving satisfaction and clinical outcomes

• Develop skills in effective communication

• How to build rapport – verbal and non verbal behaviours

• How to gather information – questioning techniques

• Listening techniques – picking up on cues – verbal and non-verbal

• Determining patient expectations of treatment (these may differ from HCP)

• Giving information and addressing concerns – how to give the right quantity and quality of information – how do you know when enough is enough or too little?

Your personal goals

• Please complete the worksheet provided, to capture your own starting point, and goals for the session

Your perspectiveWhat strategies have you found useful to enhance adherence?

Describe your communication style or traits –select from list or add your own:

What do you want to achieve from this workshop?

What do you think are the key adherence issues in psoriasis?