Communication Strategies

1. Communication Strategies #1 Strategy: Talk, Care and Connect

2. Create A Favorable Environment Establish Privacy Reduce Physical Barriers

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

4. Determine Beliefs • Cultural influences • Beliefs about illness • Value of illness

5. Recognize and Adapt to Person’s Internal “Noise” • High anxiety persons: • Share overall conclusions first • Low anxiety persons • Build toward conclusion

6. 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)

7. Build a Two-Way Communication Partnership • Adult-Adult: Empowers Choices • Information • Insight • Empathy • Confidence • Parent-Child: Gives Advice • Child-Child: Makes Demands

8. An Adult Approach…. • “I’m here to help you get the most benefit from your medication.”

9. 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

10. 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

11. 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”

12. Introverted PharmacistsAchieve Greater Compliance • They are perceived as • More trustworthy • Less overbearing

13. HelpfulCommunication Factors For Better Adherence Deliver: • Explicit and appropriate instructions • More and clearer information • More and better feedback

14. 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

15. 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

16. Verbal Strategies • Speak Clearly • Avoid jargon • Explain WHY/WHY NOT • Limit message length • Establish 3-5 key messages • Repeat important content

17. 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

18. 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

19. 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

20. 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

21. Communicate ViaMultiple Modalities • Speech • Written materials • be alert to non-readers • Graphics • Models • Demos For best results: employ both oral and written presentations

22. Build Message Redundancy • T1 --Explain what you will tell the patient • T2 -- Tell it • T3 -- Review what you told them

23. 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

24. Enlist Others • Work with MD to: • Simplify regimen • Reduce number of daily dosage intervals • Adjust to person’s daily routine • Enlist family support

25. Be Creative • Supply medication reminders • Organizers • Alarms • Check-off sheets • Contracts • Remind of refills by mail or telephone

26. 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

27. Therefore, Provide Both… • Accurate Factual Information • Positive Emotional Aspects

28. 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

29. 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 strategiesto increase patient well-being.