KHA359 Lecture Notes - Lecture 8: Guided Imagery, Groupthink, Unwell
30 Jun 2018
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Department
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Professor
Health Psychology week 8: Developing a bedside manner
Medical consultation:
- Key goals:
oDeveloping a good relationship between health care provider and
patient
oExchanging relevant information
oMaking relevant decision
- Phases: there are a number
- Ford: 6 key dimensions
oHaving good knowledge about condition
oGood communication
oEstablish relationship with patient and good communication
oEstablish nature of the medical problem
oGaining understanding of the patients understanding of the problem
oEngaging patient in decision making process
oManaging time
- Professional centered approach: doctor knows best
oProfessional keep control over the interview
oPower is exacerbated by the patient
They think the doctor will know everything
By patient behaviour: reluctant to question the doctor
oDoctor has responsibility for making decisions
oThey ask questions to gain information
Direct
Closed ended
Refer to medical or other facts
oPatient passively accepts the decision
oLittle room to allow patient opinions
- Patient centred approach:
oHealth professional identified and works with patients agenda
oAs well as their own
oActively listen to patient and respond accurately
oCharacterised by professionals encouraging patient engagement
oSeeking their ideas about what they want and whether they think the
doctor is right or wrong
oThe effectiveness is dependent on the patient involved
oDoesn’t work for everybody
- Preferences may differ
oRegarding whether patients want involvement in the process
oWomen in breast surgery
oWhether or not they spoke to oncologist didn’t increase their likelihood
of receiving surgery
oLevel of satisfaction is significantly higher with treatment choice
involvement
oHappy they participated in the process and happy with the amount of
information they received
oThis differed between Massachusetts and Minnesota
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oDependent on the person and regions and cultures
The latter is more conservative
- Shared decision making consultation:
oShared decisions involve at least two or more participants
The health care professionals and the patient
oBoth parties collaborate
oBoth parties take steps to participate in the process of treatment
decision making
oInformation sharing is prerequisite in the process of
oA treatment decision is made and both parties agree with the decision
oSteps of this:
Explore the patients ideas about the nature of the problem and
potential treatments
Identify how much information the patient would prefer and
tailor to this
Check understanding of fears, ideas and expectations
Adopt preferences
Make discuss and defer decisions
Arrange follow up
oPositive:
Allows easier for patients
Not an easy task for patients to make decisions:
Lacks a framework of medical decision making
Lacks medical vocab
Emotional vulnerable
In a new environment
Possibly feeling powerless
oProvide counseling
oChallenges:
Power differential between patient and healthcare professional
More relevant knowledge on the HCPs side
Many patients prefer asymmetry
Worries about their being no clear treatment or mixed
evidence
Prescribing treatment by trusted authority might confer
certainly and reassurance in the treatment
- Australian charter of healthcare rights:
oIn Australia there is strong support for patient centred and shared
decision approach
oRecommended in 2010
- Australian Government: communicating with patients guidelines
oActive listening: how to do so
oAssisting the patient: directly
oHelping understanding:
oCommunicate so they can make informed decisions
oHow to communicate bad news
oWhen to withhold information
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oWhen to use outside parties: interpreters and advocates
- Presenting information to patients:
oCommunication of information needs to be done in the most well
understood format
oFace to face interview
oRepetition of key pieces of information is important
oUsing diagrams also encouraged in consultation
- Preferences for consultation style:
oEven though shared is currently preferred, not for everyone
o1000 patients with either breast cancer of who were receiving stem cell
replants
oonly minority opted for shared: usually sat either side of it (doctor or
patient approaches)
ocharacteristics:
younger participants like to play role in decision
females also
more educated want to play active role
as with depressed
active coping styles
less likely to if: older, male, less educated, hypertension,
diabetes/heart disease
the latter are two who value health outcomes highly
oinvestigation:
more than just preference for shared decision making
recorded consultations of 236 patients
predictors of patients:
if you were not married more likely to discuss your
preference for decision making
as well with longer consultation times
- Outcomes of adhering to preferred role:
oPatients whose preferences were met had greater satisfaction
Regardless of initial preference
Fewer unmet need
Informational wise
Felt that needs were met regarding talking about fears
Felt like they were being looked after
Lower levels of anxiety following consultation
oAnother study:
Less knowledge given to patient when shared consultation
But there was an increased satisfaction
Doctors trained in shared processes had higher perceived levels
of wellbeing
Knowledge comment: turns out they had higher risk factors for
diabetes as well
If in control group; lower BMI and good blood pressure
The intervention group where shared processes was
made; higher BMI and blood pressure
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Health psychology week 8: developing a bedside manner. Key goals: developing a good relationship between health care provider and patient, exchanging relevant information, making relevant decision. Professional centered approach: doctor knows best: professional keep control over the interview, power is exacerbated by the patient. They think the doctor will know everything. By patient behaviour: reluctant to question the doctor: doctor has responsibility for making decisions, they ask questions to gain information. Refer to medical or other facts: patient passively accepts the decision, little room to allow patient opinions. Shared decision making consultation: shared decisions involve at least two or more participants. Explore the patients ideas about the nature of the problem and potential treatments. Identify how much information the patient would prefer and tailor to this. Check understanding of fears, ideas and expectations. Not an easy task for patients to make decisions: Lacks a framework of medical decision making. Possibly feeling powerless: provide counseling, challenges:
