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.


A doctor’s Issue

A doctor’s Issue


Especially when it comes to preventive care.

What a doctor should learn to recognize first is the:


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….?


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


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


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


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?

;)


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


How to speak?



Explain the preventive nature of the Papanicolaou test


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



It prevents precancerous

lesions way before they become

cancer


back



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


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


Say instead


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


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


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;


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


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


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


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


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


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..?


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


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


Willingness: The Importance of Change


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.


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


Interview

Do you know that you can prevent its

occurrence?

What should I do?


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


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?


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


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


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


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;


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

Yes..but

Summary


true

false

true

false

Yes..but

References: click here


Very goodVery good

Yes..but


You havenYou haven’’t t learned much!learned much!

Yes..but

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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.

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2 nd Module: Communication Skills for Healthcare Professionals