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Ambulatory
Care
Patient Education and Behavior Change
In this workshop students will learn how to effectively educate patients
and motivate patients to change behaviors. Three examples-obesity, tobacco
and alcohol use.
Videotape Review*
Students are asked to videotape a patient encounter at their clinical
site. Each videotape will be
reviewed within a small group including a faculty member. The review will
focus on the Core Communication Skills as well as any specific skills
relevant to that particular patient.
Simulated Patient Experience*
Students will have the opportunity to practice their communication and
physical exam skills with
simulated patients. They will also be directly observed and receive feedback
on their skills. Performance in the activity will not be graded, although
you are expected to participate.
* These activities existed before the Macy Initiative.
Patient Education and Behavior Change
Goals:
Asses patient's readiness for change
Elicit patient's understanding and concerns
Use appropriate transition statements to move patient to the next stage
Arrive at mutually acceptable solution
Check patient's willingness and ability to follow the plan
Communicate non-judgmental and supportive attitude
Outline:
Discussion 15 minutes
How do people change?
Prochaska/DiClemente
6 stages, learning needs/skills for each stage
What helps? Facilitating Change
Asses patient's stage/needs-state problem and check-in (What do you
know about, how do you feel about….?)
Target conversation towards appropriate stage
- Pre-contemplative-explore patient's health beliefs
and
priorities, educate and negotiate.
- Contemplative-Ambivalent, make 2x2 table, decision
balance.Help the patient make their own decision. Explore confidence.
- Preparation- Negotiate personalized plan for patient.
Support self-efficacy, increase confidence.
- Action-Help patient enlist support from others,
offer your Support, work on skills.
- Maintenance-Trouble-shoot, encourage, support.
- Relapse-Assist in coping, use as learning opportunity.
Role Plays 45 minutes
Case #1 Obesity-Demonstration
Case #2 Alcohol Use-pair up with another student
Case #3 Smoking-switch roles
Case #1 Patient
30 year old female, at doctors for routine visit.
Mild osteoarthritis and borderline hypertension.
Doctor will ask about your weight.You
would like to lose weight.You have tried in the
past, lost 5-10 pounds initially on SlimFast, but gained most of it back
over a period of weeks.You are ambivalent-you would
like to lost about 15 pounds (170-155), you know it would be good for
your health and you would get out more. You do not have much confidence
in keeping weight off.You eat more when you get
stressed out and do not enjoy exercising (you like to play volleyball,
but have not been on a team in over 5 years).
Case #1 Doctor
30 year old female, here for routine visit.
History: You have completed the history, she is
doing
well besides mild osteoarthritis in her knees.
No other medical problems and takes Motrin PRN.
Physical Exam: 140/80, Weight 170, 5'4" (BMI
29) otherwise normal. You would like to discuss
weight loss with her.
Case #2 Patient
You are a 50 year old male with a history of mild hypertension and
occasional dyspepsia. You are here for a follow-up visit.
Alcohol history:
You drink on average 2 drinks/night, you go out with friends after work
or make a drink once you get home. If asked specifics you sometimes have
5-6 drinks a night (1-2x/week)
and have a hard time getting up most mornings. Answer to CAGE:
C-You did try to cut down once several years ago before your divorce,
but Since then have not tried.
A-Your ex-wife used to get upset when you drank (said you would get argumentative
and explosive).
G-never guilty
E-no eye opener.
At this time you do not think your drinking is
a problem. You have lived for 50 years without any health problems and
it helps you relax and is a socialactivity.
Case #2 Doctor
This is a 50 year old man with mild hypertension
and dyspepsia
(takes Norvasc and occasional antacid). He is here for follow-up
you would like to explore his alcohol use.
Case #3 Patient
You are a 35 year old women with no medical
problems who
is here for a follow-up visit with your physician. Last
visit (3 mo ago) you had discussed quitting smoking. You tried the
patch which helped and you did not smoke for 2 months.
However, over the last 3 weeks you have started smoking again. Your job
has required lots of travel in the car, and smoking always helped pass
the time in the car. After a stressful week 3 weeks ago you had one cigarette
which led to a pack, and then now you are back to ½ pack/day. You
feel ashamed and weak. You would like to stop again, but not sure how
to be successful.
Case #3 Doctor
The patient is a 35 year old women with no
medical problems who
is here for a follow-up visit. Last visit (3 mo ago) she agreed to
stop smoking (using the patch) and you would like to see how
that is going.
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