women for positive action is an educational program funded and initiated by abbott laboratories
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Getting the most from the therapeutic relationship with your healthcare professional Angelina Namiba and Lorraine Sherr Women for Positive Action. Women for Positive Action is an educational program funded and initiated by Abbott Laboratories. Women for Positive Action. Angelina Namiba, UK. - PowerPoint PPT PresentationTRANSCRIPT
Getting the most from the therapeutic
relationship with your healthcare professional
Angelina Namiba and Lorraine SherrWomen for Positive Action
Women for Positive Action is an educational program funded and initiated by Abbott Laboratories
Women for Positive Action
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Angelina Namiba, UK
Lorraine Sherr, UK
Women for Positive Action
3
www.womenforpositiveaction.org Contact us: [email protected]
Twitter: @WFPA_HIV
Women for Positive Action is a global initiative established to address the
specific concerns of women living and working with HIV
Women for Positive Action is led by a faculty of healthcare professionals,
women living with HIV and community group representatives from across Canada, Europe, Latin America and
South Africa
WFPA mission
To empower, educate and support women with HIV and the healthcare professionals and
community advocates/leaders involved in their treatment
To explore the issues facing women with HIV and provide meaningful education-based
support to respond to these needs
To contribute towards an enhanced quality of life for women with HIV
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Workshop objectives
To discuss challenges that can be addressed through partnership
between women living with HIV and their healthcare professional
To explain the importance of an effective
therapeutic relationship with your healthcare professionalProvide practical advice on
maximising the benefits of the therapeutic relationship for
individualised care
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Introduction
Special considerations for women living with HIV
The importance of the therapeutic relationship
Discussion
Special considerations for
women living with HIV
Angelina Namiba
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What are the issues facing women diagnosed with HIV?
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Denial
Disclosure(often avoided)
Depression(can continue)
-
+
optimal journeyemotional disturbance and depression
Stigma, shame blame,
rejection
Stigma, shame blame,
rejection
Pregnancy, job loss, negative life
events(at any stage)
Side effects
Starting treatment
Diagnosis
Acceptance / moving on
How women experience HIV: the journey
Imp
rovem
en
t in
em
oti
on
al w
ellb
ein
g
The journey is characterised by many emotional ups and downs and varies from woman to woman. It adheres to the
classic grieving modelThe Planning Shop International Women Research, July 2008
The challenge of . . . diagnosis
Social and cultural
circumstances
Sorrow
AcceptanceAnger
Starting treatment
and adherence
Grief
DisclosureDenial Fear
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What does a woman living with HIVneed from the therapeutic relationship?
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The challenge of... disclosure
Barriers . . .
Blame, upsetting family
Rejection, accusations of infidelity
Abandonment
Loss of economic support
Violence (up to 60%)1
Stigma
Discrimination
Motivators . . .
Sense of ethical responsibility
Concern for partner's health
Symptoms and severity of illness
Need for social support
Need to alleviate stress of non-disclosure
To facilitate treatment, safe sex and HIV-prevention behaviour
WHO. Gender inequalities and HIV 2008; WHO. HIV status disclosure to sexual partners: rates,
barriers and outcome for women
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Facilitating disclosure
Discuss the need to inform others during pre- and post-test
counselling
Address mandatory disclosure and the role of the clinician
Emphasize the positive aspects of disclosure
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What are some of the issues that a woman faces when starting HIV treatment?
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The challenge of starting treatment
Barriers to overcome before initiating treatment1,2
Preference for
alternative treatments
Communication problems
Low self-worth
Lifestyle issues
Lack of trust in clinician
Lack of acceptanc
e of diagnosis
Fear of side
effects
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CD4 count and viral load
missed doses may allow the virus to replicate more rapidly and damage the
immune system
The challenge of . . . starting treatment
Treatment adherence is critical to:
1Prevent ART
resistance missed doses may encourage new drug-
resistant strains of HIV to develop
2
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How do you think we can be supported?
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Individualizing care
We must be considered in our social context
e.g. as a mother, a partner, a daughter, a caregiver
(or all of the above)
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Women also have social and cultural challenges
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FaithMarginalized
Multi-tasking Isolation
Access
Language
SexViolencePower/control
Social and cultural differences affect how women manage HIV
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Individualizing care
HIV care should vary depending on the unique needs
and personal circumstances of each woman . . .
Matching care to women’s needs
• A little investment at the beginning of a woman’s care can have long lasting beneficial implications!
The importance of the
therapeutic relationship
Lorraine Sherr
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Successful patient–doctor partnerships
• In general, women have good experiences with their physicians and do not have a gender preference1
• Most physicians believe they are empathetic toward their patients
A good relationship is good for you
Pro-activity in healthcare decisions3
Treatment adherence2,4,5 Improved patient self-care6
Belief in the usefulness of treatment2
Health outcomes3 Self-efficacy2
Satisfaction1,2
A patient-centred working alliance is associated with improved outcomes:
. . . and helps women remain in care7
1. Levinson & Roter, 1995; 2. Fuertes et al, 2007; Gerbert et al. 1999; Schneider et al. 2004; Sherr et al. 2008; 6. Defining the patient-physician relationship for the 21° Century.
3rd Annual Disease Management Outcomes Summit. 2003; Mallinson et al. 2007
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Why support the therapeutic relationship?
Positive relationship
Empower women to be active partners
in their own healthcare
Help women to cope with HIV-related challenges
Support
Trust
Respect Compassion
Communication
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Health benefits of feeling “known as a person’’
0
10
20
30
40
50
60
70
80
No Don't know Yes
Beach MC et al. J Gen Intern Med 2006
Percent of patients (n=1743)
Receiving HAART
Adherent to HAART
Undetectable HIV-RNA
• Patients “known as a person’’ by their HCP were more likely to receive ART, adhere to their ART, and have an undetectable viral load
• They also reported higher quality-of-life, fewer missed appointments, more positive beliefs about therapy, less social stress and less use of drugs or alcohol
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Health benefits of feeling “known as a person’’
Beach MC et al. J Gen Intern Med 2006
• Patients “known as a person’’ by their clinician were more likely to receive ART, adhere to their ART, and have an undetectable viral load
• They also reported higher quality-of-life, fewer missed appointments, more positive beliefs about therapy, less social stress and less misuse of drugs or alcohol
0
10
20
30
40
50
60
70
80
Receiving HAART
Adherent to Haart
Undetectable HIV-RNA
No
Don’t know
Yes
Percent of patients (n=1743)
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Good doctor-patient communication is associated with better health outcomes
Clucas C et al. HIV Med 2011
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Why might women be reluctant to ask their healthcare
professional questions?
Which questions do they find the most difficult to ask?
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• Lack of continuity of care
• Institutional, cultural or language differences
• New medical technologies
• Government regulations, reimbursement and costs
• Eligibility for treatment
• Legal issues
• Changing social norms
• Understanding
• Fears
• Challenge of adhering
• Negative feelings
• Lack of confidence
• Intimidation
• Rapport failure
Potential barriers to a successful partnership
Person issues Other issues
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Seven principal elements to a successful patient-doctor relationship
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Communication
Out-patient
experience
In-patient hospital
experience
Patient education
Integration/
continuity
Decision-making
Outcomes
Disease Management Outcomes Summit 2003
CARE
COMPASSION
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Understanding aspects and models of the patient–HCP relationship
• Warmth and empathy in the approach to the patient–HCP relationship
• The technical aspects of care such as tests and examinations, prescribing treatments
Instrumental
Expressive
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• Physician recommends and patient cooperates
• “Doctor knows best" is supportive and non-authoritarian, yet is responsible for choosing the appropriate treatment
• The patient, having lesser power, is expected to follow the recommendations of the physician
• Physician actively treats the patient, patient is passive
• Patient seeks information and technical assistance
• Physician formulates decisions which the patient must accept
• Often not optimal for long-term success and satisfaction
Active-Passive Guidance-Cooperation
• Physician and patient share responsibility for making decisions and planning the course of treatment
• The patient and physician respect of each others expectations and values
Mutual Participation
Different types of relationships
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Valuing psychosocial issues in addition to ‘medical’ issues
• Clinicians who considered psychosocial aspects of a person’s life as important were more likely to express reassurance, empathy or concern and use more open-ended questions than those who focused only on medical aspects
Clinician
• Patients of these clinicians were more likely to discuss their feelings, express positive emotions and take a partnership role, and less likely to show anger or anxiety
Women
Question and elicit information
Raise psychosocial as well as medical issues
Participate in decision making
Levinson & Roter. J Gen Intern Med 1995
Empowering women to be active participants in their own care
The preferred model of medical care has evolved towards a partnership or
alliance approach
Women are encouraged to:1–4
Question and elicit information from your clinican
Raise psychosocial as well as medical issues
Participate in decision making
Take responsibility for their well-being
1. Butow P et al. J Clin Oncol 2004; 22(21): 4401–44092. Kidd J et al. Patient Educ Couns 2004; 52: 107–1123. Haywood K et al. Patient Educ Couns 2006; 63: 12–234. Levinson & Roter. J Gen Intern Med 1995; 10: 375–379
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What can women and their clinicians do to ensure that they make the most
out of the therapeutic relationship?
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Asking questions
Enabling Questions
Prepare and prioritise questions before your consultation
Write your questions down
Note down key points during your consultation
WomenClinician
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• Build a good relationship• Make the most of it
Thank you for your attention