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Getting the most from the therapeutic relationship with your healthcare professional Angelina Namiba and Lorraine Sherr Women for Positive Action. Women for Positive Action is an educational program funded and initiated by Abbott Laboratories. Women for Positive Action. Angelina Namiba, UK.

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Getting the most from the therapeutic relationship with your healthcare professional Angelina Namiba and Lorraine SherrWomen for Positive Action

Women for Positive Action is an educational program funded and initiated by Abbott Laboratories


Women for positive action
Women for Positive Action healthcare professional

Angelina Namiba, UK

Lorraine Sherr, UK


Women for positive action1
Women for Positive Action healthcare professional

Women for Positive Action is a global initiative established to address the specific concerns of women living and working with HIV

Women for Positive Action is led by a faculty of healthcare professionals, women living with HIV and community group representatives from across Canada, Europe, Latin America and South Africa

www.womenforpositiveaction.org

Contact us: [email protected]

Twitter: @WFPA_HIV


Wfpa mission
WFPA mission healthcare professional

To empower, educate and support women with HIV and the healthcare professionals and community advocates/leaders involved in their treatment

To explore the issues facing women with HIV and provide meaningful education-based support to respond to these needs

To contribute towards an enhanced quality of life for women with HIV

4


Workshop objectives
Workshop objectives healthcare professional

To discuss challenges that can be addressed through partnership between women living with HIV and their healthcare professional

To explain the importance of an effective

therapeutic relationship with your healthcare

professional

Provide practical advice on maximising the benefits of the therapeutic relationship for individualised care


Introduction healthcare professional

Special considerations for women living with HIV

The importance of the therapeutic relationship

Discussion


Special considerations for women living with hiv angelina namiba

Special considerations for women living healthcare professional with HIVAngelina Namiba


What are the issues facing healthcare professional

women diagnosed with HIV?


How women experience hiv the journey
How women experience HIV: healthcare professional the journey

+

Acceptance / moving on

Starting

treatment

Disclosure

(often avoided)

Pregnancy, job loss, negative life events

(at any stage)

Improvement in

emotional wellbeing

Side effects

Stigma, shame blame,rejection

Stigma, shame blame,rejection

Denial

Depression(can continue)

Diagnosis

-

optimal journey

emotional disturbance and depression

The journey is characterised by many emotional ups and downs and varies from woman to woman. It adheres to the classic grieving model

The Planning Shop International Women Research, July 2008

9


The challenge of diagnosis
The challenge of . . . diagnosis healthcare professional

Denial

Fear

Disclosure

Sorrow

Grief

Starting treatment and adherence

Anger

Acceptance

Social and cultural circumstances


What does a woman living with HIV healthcare professional

need from the therapeutic relationship?


The challenge of disclosure
The challenge of... disclosure healthcare professional

Barriers . . .

Blame, upsetting family

Rejection, accusations of infidelity

Abandonment

Loss of economic support

Violence (up to 60%)1

Stigma

Discrimination

Motivators . . .

Sense of ethical responsibility

Concern for partner's health

Symptoms and severity of illness

Need for social support

Need to alleviate stress of

non-disclosure

To facilitate treatment, safe sex

and HIV-prevention behaviour

WHO. Gender inequalities and HIV 2008; WHO. HIV status disclosure to sexual partners: rates, barriers and outcome for women


Facilitating disclosure
Facilitating disclosure healthcare professional

Discuss theneed to inform othersduring pre- and post-test counselling

Addressmandatory disclosureand the role of the clinician

Emphasize thepositive aspectsof disclosure


What are some of the issues that a woman healthcare professional faces when starting HIV treatment?


The challenge of starting treatment
The challenge of starting treatment healthcare professional

Barriers to overcome

before initiating treatment1,2

Fear of side effects

Lifestyle issues

Lack of acceptance of diagnosis

Low self-worth

Lack of trust in clinician

Communication problems

Preference for alternative treatments


The challenge of starting treatment1
The challenge of . . . starting treatment healthcare professional

Treatment adherence is critical to:

CD4 count and viral load

missed doses may allow the virus to replicate more rapidly and damage the immune system

1

Prevent ART resistance

missed doses may encourage new drug-resistant strains of HIV to develop

2


How do you think we can be healthcare professional

supported?


Individualizing care
Individualizing care healthcare professional

We must be considered in our social contexte.g. as a mother, a partner, a daughter, a caregiver (or all of the above)


Women also have social and healthcare professional

cultural challenges


Social and cultural differences affect how women manage hiv
Social and cultural differences affect how women manage HIV healthcare professional

Sex

Power/control

Violence

Isolation

Multi-tasking

Language

Faith

Access

Marginalized

20


Individualizing care1
Individualizing care healthcare professional

HIV care should vary depending on the unique needs and personal circumstances of each woman . . .


Matching care to women s needs
Matching care to women’s needs healthcare professional

  • A little investment at the beginning of a woman’s care can have long lasting beneficial implications!


The importance of the therapeutic relationship lorraine sherr

The importance of the therapeutic relationship healthcare professional Lorraine Sherr


Successful patient doctor partnerships

In general, women have healthcare professional good experiences with their physicians and do not have a gender preference1

Most physicians believe they are empathetic toward their patients

Successful patient–doctor partnerships


A good relationship is good for you
A good relationship is good for you healthcare professional

Satisfaction1,2

Health outcomes3 Self-efficacy2

Belief in the usefulness of treatment2

Treatment adherence2,4,5 Improved patient self-care6

Pro-activity in healthcare decisions3

A patient-centred working alliance is associated with improved outcomes:

. . . and helps women remain in care7

1. Levinson & Roter, 1995; 2. Fuertes et al, 2007; Gerbert et al. 1999; Schneider et al. 2004; Sherr et al. 2008; 6. Defining the patient-physician relationship for the 21° Century. 3rd Annual Disease Management Outcomes Summit. 2003; Mallinson et al. 2007


Why support the therapeutic relationship
Why support the therapeutic relationship? healthcare professional

Empower women to be active partners in their own healthcare

Help women to cope with HIV-related challenges

Support

Positive relationship

Trust

Communication

Compassion

Respect


Health benefits of feeling known as a person
Health benefits of healthcare professional feeling “known as a person’’

Percent of patients (n=1743)

  • Patients “known as a person’’ by their HCP were more likely to receive ART, adhere to their ART, and have an undetectable viral load

  • They also reported higher quality-of-life, fewer missed appointments, more positive beliefs about therapy, less social stress and less use of drugs or alcohol

Receiving HAART

Adherent to HAART

Undetectable HIV-RNA

Beach MC et al. J Gen Intern Med 2006


Health benefits of feeling known as a person1
Health benefits of healthcare professional feeling “known as a person’’

Percent of patients (n=1743)

  • Patients “known as a person’’ by their clinician were more likely to receive ART, adhere to their ART, and have an undetectable viral load

  • They also reported higher quality-of-life, fewer missed appointments, more positive beliefs about therapy, less social stress and less misuse of drugs or alcohol

No

Don’t know

Yes

Beach MC et al. J Gen Intern Med 2006


Good doctor-patient communication is associated with better health outcomes

Clucas C et al. HIV Med 2011


Why might women be health outcomes

reluctant to ask their healthcare

professional questions?

Which questions do they find

the most difficult to ask?


Potential barriers to a successful partnership
Potential barriers to a successful partnership health outcomes

Person issues

  • Understanding

  • Fears

  • Challenge of adhering

  • Negative feelings

  • Lack of confidence

  • Intimidation

  • Rapport failure

Other issues

  • Lack of continuity of care

  • Institutional, cultural or language differences

  • New medical technologies

  • Government regulations, reimbursement and costs

  • Eligibility for treatment

  • Legal issues

  • Changing social norms


Seven principal elements to a successful patient doctor relationship
Seven principal elements to a successful patient-doctor relationship

C

O

M

P

A

S

S

I

O

N

Communication

Out-patient experience

C

A

R

E

7

Outcomes

Decision-making

In-patient hospital experience

Integration/continuity

Patient education

Disease Management Outcomes Summit 2003


Understanding aspects and models of the patient hcp relationship
Understanding aspects and models of the patient–HCP relationship

Instrumental

  • The technical aspects of care such as tests and examinations, prescribing treatments

Expressive

  • Warmth and empathy in the approach to the patient–HCP relationship


Different types of relationships
Different types of relationships relationship

  • Physician actively treats the patient, patient is passive

  • Patient seeks information and technical assistance

  • Physician formulates decisions which the patient must accept

  • Often not optimal for long-term success and satisfaction

Active-Passive

  • Physician recommends and patient cooperates

  • “Doctor knows best" is supportive and non-authoritarian, yet is responsible for choosing the appropriate treatment

  • The patient, having lesser power, is expected to follow the recommendations of the physician

Guidance-Cooperation

  • Physician and patient share responsibility for making decisions and planning the course of treatment

  • The patient and physician respect of each others expectations and values

Mutual Participation

34


Valuing psychosocial issues in addition to medical issues
Valuing psychosocial issues in addition to ‘medical’ issues

Women

  • Patients of these clinicians were more likely to discuss their feelings, express positive emotions and take a partnership role, and less likely to show anger or anxiety

Question and elicit information

Raise psychosocial as well as medical issues

Participate in decision making

Clinician

  • Clinicians who considered psychosocial aspects of a person’s life as important were more likely to express reassurance, empathy or concern and use more open-ended questions than those who focused only on medical aspects

Levinson & Roter. J Gen Intern Med 1995


Empowering women to be active participants in their own care
Empowering women to be active participants in their own care issues

The preferred model of medical care has evolved towards a partnership or alliance approach

Women are encouraged to:1–4

Question and elicit information from your clinican

Raise psychosocial as well as medical issues

Participate in decision making

Take responsibility for their well-being

1. Butow P et al. J Clin Oncol 2004; 22(21): 4401–4409

2. Kidd J et al. Patient Educ Couns 2004; 52: 107–112

3. Haywood K et al. Patient Educ Couns 2006; 63: 12–23

4. Levinson & Roter. J Gen Intern Med 1995; 10: 375–379


What can women and their clinicians issues

do to ensure that they make the most

out of the therapeutic relationship?


Asking questions
Asking questions issues

Enabling Questions

Women

Clinician

Prepare and prioritise questions

before your consultation

Write your questions down

Note down key points during your consultation




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