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Concordance Consultation Skills

Key Slides. Concordance Consultation Skills. Concordance can be defined as. ‘Shared decision making about medicines between a healthcare professional and a patient, based on partnership, where the patient’s expertise and beliefs are fully valued’

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Concordance Consultation Skills

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  1. Key Slides Concordance Consultation Skills

  2. Concordance can be defined as.. ‘Shared decision making about medicines between a healthcare professional and a patient, based on partnership, where the patient’s expertise and beliefs are fully valued’ Weiss M and Britten N. Pharmaceutical Journal 271 (493)

  3. % Patients wanting to be more involved in decisions about treatment Cassileth B R, Zupkis R V, Sutton-Smith K, March V. Annals of Internal Medicine 1980 92: 832–836

  4. Doctor always/usually involves patient in treatment decisions Picker Institute (April 2006). Engaging patients in their healthcare: How is the UK doing relative to other countries? http://www.pickereurope.org/Filestore/PIE_reports/project_reports/Six_country_study_with_ISBN_web.pdf

  5. Directing versus sharing style Sharing style resulted in • Excellent explanation • Excellent understanding • Overall higher satisfaction • No statistically significant increase in consultation length Savage R, Armstrong D. Effect of a general practitioner’s consulting style on patients’ satisfaction: a controlled study. Br Med J 1990; 301 (6758): 968-970

  6. Patient centred, clinician directed Patient’s wants and needs Clinician leads, structures and focuses

  7. A concordant practitioner should… • Be well informed about the patient’s medical condition, it’s effects and treatment • Be knowledgeable but aware of the limits of their own knowledge • Avoid the use of inappropriate jargon • Plan a structured consultation with a clear agenda that is followed • Be empathic - demonstrate that they understand the patient’s perspective See G Elwyn et al. Qual Saf Health Care 2003;12:93-99 http://qshc.bmj.com/content/12/2/93.full for the OPTIONS scale

  8. Open questions • Invite an extended response from the patient • Cannot usually be answered by a yes/no response • Do not assume a particular response from the patient

  9. Reflective listening • Enables the healthcare professional to check the patient’s meaning • Demonstrates that the healthcare professional has understood the patient • Plays a role in conversational turn-taking and often elicits further exploration from the patient • Can be used to reflect the feelings underlying the patient’s response • If used selectively can be used to direct the patient towards further exploration of a particular issue or concern

  10. Summarising • Enables the patient and healthcare professional to ensure they have understood each other • Demonstrates that the healthcare professional has listened to and understood the patient • Structures the patient’s thoughts and concerns into a coherent whole • Structures the consultation into sections • Enables the healthcare professional to move the consultation on to a new stage

  11. Key questions • Emphasises that decisions about treatment are made by the patient • Prompts the patient to make a decision about their next step forward • Ensures that the patient is prompted to make a decision and resolve their possibly conflicting thoughts and feelings about a particular situation

  12. Eliciting self-efficacy for treatment • Increases the likelihood that people feel confident that they can follow a treatment plan including medicine-taking • Can indicate if the patient has significant level of unresolved ambivalence about their decision • Identifies skill gaps and additional assistance that may be necessary to enhance the likelihood of adherence e.g. difficulties opening containers

  13. Eliciting positive outcome expectancies and optimism for treatment • Gives the patient the opportunity to hear themselves say what the benefits of treatment are • Can ensure the session ends on a positive note • Provides the healthcare professional with the opportunity to ensure the patient has an accurate understanding of the benefits of treatment

  14. Decisional Balance ‘A tool to explore what the patient stands to lose or gain by their current behaviour and treatment or by change to their behaviour or treatment’ See: http://www.motivationalinterview.org/clinical/decisionalbalance.pdf

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