Communication Strategies

#1 Strategy:Talk, Care and Connect

Create A Favorable Environment

Establish PrivacyReduce Physical Barriers

“Size-Up” the Person’s: Credibility Health Knowledge Intellect Personality Emotional Status

Determine Beliefs Cultural influences Beliefs about illness Value of illness

Recognize and Adapt to Person’s Internal “Noise” High anxiety persons:

Share overall conclusions first Low anxiety persons

Build toward conclusion

Employ Positive Non-Verbal Behaviors Forward lean Silence—listen Good eye contact Warm expression Postural synchrony Open posture (uncross arms) Limit self-adaptors (touching self)

Build a Two-Way Communication Partnership Adult-Adult: Empowers Choices

Information Insight Empathy Confidence

Parent-Child: Gives Advice Child-Child: Makes Demands

An Adult Approach…. “I’m here to help you get the most

benefit from your medication.”

Avoid “I-It” Relationships

Martin Buber’s Schema… I-IT

Impersonal; doesn’t acknowledge person

I- You Businesslike, professional or personal

I-Thou Empathetic with great understanding

There is No Substitute for Genuine Caring!! Show real empathy Personalize the message

Use the patient’s name Engage them in the conversation Identify and relate to their needs

Create Credibility Present a Professional Appearance Assume a Professional Affect Establish Trust

Go slow Follow-through Display genuine interest Allow the person to “save face”

Establish Appropriate “Distance” and “Boundaries”

Introverted PharmacistsAchieve Greater Compliance They are perceived as

More trustworthy Less overbearing

HelpfulCommunication Factors

For Better Adherence Deliver: Explicit and appropriate instructions More and clearer information More and better feedback

Organize the Session

Introduce self and provide a brief orienting statement

Assess the person’s anxiety and beliefs Prioritize and structure information- giving

to span 3-5 main points Employ transitions between ideas Closing

Summarize key points Provide written information, even to the

most educated patient

Strategies to Detect Non-Adherence Gather Objective Data

Refill information and objective lab values Interview Person

but not via “an inquisition” Brown-bag Programs

Patients bring all of their medications in a bag to the pharmacist for counseling

Compliance Clinics

Verbal Strategies Speak Clearly Avoid jargon Explain WHY/WHY NOT Limit message length

Establish 3-5 key messages Repeat important content

Probe for Understanding

This is an ethical responsibility “The basic and most common cause

of non-compliance is the patient who does not understand that is expected.” Frank E. Young MD Ph.D.Former FDA Commissioner

Strategies to Verify Understanding Gentle Probes

“What will you do?” “Show me….” “Why?”

Ask the person to review the content of your counseling

Ask the person to predict the medication’s effects

Provide Information-Pt 1 Be persuasive! Describe use Inform about side effects

Research shows: this does not increase side effects

Tell when and how medication will help Avoid being too complicated or detailed

Provide Information-Pt 2 Explain benefits of medication Raise awareness of body cues Explain ways person can self-

evaluate therapy Help develop coping mechanisms Don’t insist that the patient comply

Communicate ViaMultiple Modalities Speech Written materials

be alert to non-readers Graphics Models DemosFor best results: employ both oral and

written presentations

Build Message Redundancy T1 --Explain what you will tell the

patient T2 -- Tell it T3 -- Review what you told them

Communicate Frequently Encourage future communication

Suggest calling to discuss concerns Refill counseling is an important

opportunity to: Identify changing beliefs about illness Identify side effects which may lead to

non-adherence

Enlist Others Work with MD to:

Simplify regimen Reduce number of daily dosage

intervals Adjust to person’s daily routine

Enlist family support

Be Creative Supply medication reminders

Organizers Alarms Check-off sheets Contracts

Remind of refills by mail or telephone

It’s Not Just About Information… The lower the patient satisfaction

with the interaction, the greater the likelihood of non-adherence

There is no substitute for a warm and caring relationship

Therefore, Provide Both… Accurate Factual Information Positive Emotional Aspects

Human Interaction Increases Adherence Non-adherence was reduced by 25%

when the pharmacist, rather than the clerk, handed the medication to the patient.

Patient involvement increases adherence

In closing

We have discussed the differences between patient compliance, and patient adherence. The latter is a more complex and inclusive construct.We also considered several reasons why patients do not adhere to treatment regimens, and how healthcare professionals can employ effective communication strategies to increase patient well-being.