Last week our behavioral and creative teams had the privilege of receiving a 1-day health coach training from experts at the UNC-Greensboro Department of Public Health Education. This training was a unique opportunity to learn best practices when working with patients in the most intimate of settings: a health coaching session.
The dynamic day included an explanation of the 3 different styles of communication used in coaching: Directing, Guiding, and Following.
“Directing” takes place when the coach tells the patient what to do and the best way to do it. “Following”, on the other hand, has the coach openly listening with no agenda, and following along with whatever the patient wants to discuss. The “Guiding” style is when the coach affirms that the patient is capable, and works to increase the patient’s ability to change the desired behavior, guiding them through questions and conclusions rather than dictating them.
It was interesting to learn from this training that, though guiding may be favored in our changing healthcare environment, there is a time and place for each of the 3 styles of communication in talking with patients. There are times when, for the patient to understand the gravity of a diagnosis or necessity of treatment, the doctor should use the directive communication style. The patient needs to know exactly what to do and how important it is to do it. Other times following may be most appropriate, if the patient simply needs time to have their thoughts or concerns heard.
A big part of my internship with MicroMass this summer is working on a research project that looks at the trends in doctor/patient communication and how the way in which a doctor communicates with the patient may bring about different patient outcomes. We’re currently fielding the study, and are eager to learn more about the doctor/patient relationship from people living with chronic disease. Of particular interest is learning how these different coaching styles are being used in real-world situations and how they may impact both positive and negative outcomes.
The question is –which style is most beneficial when? And how can the healthcare provider figure that out in at any given moment? We are looking forward to seeing how the results of this study bring us one step closer to finding out.(Read full post)
Recently, a friend of mine was having trouble waking up in the morning. In an effort to solve his problem, he purchased a new alarm clock that literally forces you to get up and at ‘em. “Clocky” is an alarm clock on wheels. When it goes off, it zooms around the bedroom, signaling at full volume until you leap out of bed to silence it. While Clocky may initially curb his tendency of repeatedly hitting snooze, my guess is that it won’t be long before Clocky is given the boot as the novelty wears off and the old habit kicks back in. It’s not because Clocky isn’t loud enough, or doesn’t move fast enough. It’s because Clocky doesn’t address the core barriers that lead to his difficulty in waking up in the morning, namely, drinking coffee after 12 pm, having a penchant for watching late night movies and holding a strong dislike for rush hour traffic.
In order to produce long-lasting behavior change, you must propose a solution that responds to an individual’s specific barriers. This is where there is a real opportunity for pharma companies to get into the mindset of their patients. For example, medication compliance messages for patients are often focused on setting reminders or alarms. Yet many people who are not adherent to their regimen aren’t missing their dose because they are forgetful. Those patients may have deeper challenges with taking medication such as concerns about side effects, misconceptions about how the medication works, or a misunderstanding about the severity of their illness. For those people, a reminder alarm or text won’t help, and in order to inspire change, it is necessary to go below the surface.
The way to start is to engage the patient by uncovering their specific challenges and then offering support that matches it. This can happen at the doctor’s office, at the pharmacy, or during a visit to a product website. All patients are different, but what is universal is the desire to be understood and talked to in a way that is relevant, engaging and motivating. This is what will truly get patients out of bed in the morning.(Read full post)
Last week, I attended the PH Professional Network Symposium in Crystal City, Virginia. It was a gathering of approximately 400 PH-treating allied health professionals and others working to make a difference in the field of pulmonary hypertension. I looked forward to learning from the experiences of those in the field, how they overcome obstacles with patients, and future research in PH. I was also excited to present our research poster on the Psychosocial Aspects of Living with Pulmonary Arterial Hypertension. So much focus is often put on the clinical aspects of treating a disease, and it’s just as important to understand the psychosocial components, as these can great affect medication taking patterns, mental health, and overall well being.
The Symposium was fantastic. I came back with a renewed hope for the future of this disease, in addition to learning a lot about the day-to-day of those treating it (like complex cases and medication decisions). Not surprisingly, the keynote speaker was an inspiration. It was given by Jessica Lazar, a PA at Allegheny General Hospital in Pittsburgh, Pennsylvania. She spoke about her experience climbing Mount Kilimanjaro, likening the climb and the altitude effects to what it’s like for people living with PH. Her blog describes her climb for a cure. Below is an excerpt.
“Pulmonary arterial hypertension is a curable disease. No, we don’t have the cure yet, but to me it is something I am quite hopeful will happen within my career, which has about 15 years to go. We just have to push hard enough, be dedicated enough, climb over every obstacle, and keep pushing just when we feel like sitting down. Kind of like climbing a mountain. And kind of like living with PAH. Our climb of Kilimanjaro honors all those who courageously live with PAH every day, those who courageously have died with PAH, the caregivers who are there every step of the way, the caregivers left behind when a loved one with PAH reaches the end of their struggle.”
The Symposium closed with an inspirational presentation by three clinicians, Mae Centeno, Heather Langlois and Peggy Kirkwood, treating PAH and how they’ve created and sustained a multidisciplinary, patient-centered approach to caring for their PAH patients. The time, energy, organization, and drive of these individuals really does give hope for the future of those living with this disease.(Read full post)
A recent article in the American Journal of Cardiology attempted to shed some light on the issue of physician/patient communication regarding the condition of mixed dyslipidemia. The study found that, perhaps not surprisingly, physicians tended to dominate the conversations, and only a small percentage of the time addressed disease education.
You might think this was the key takeaway from this article, but it seems like all of the attention has focused on another aspect of the study: it only mentions one therapeutic product by name and notably omits other potential treatment options. This has led to the seemingly obligatory discussion about the influence of drug marketers on scientific studies and the lack of objectivity by physicians associated with the company. Fair enough – you can clearly see who stands to benefit from this study – but let’s try to put things in perspective.
Yes, a pharma company sponsored the studies. They are often willing to invest in the kind of observational research that leads to these conclusions and that usually provide valuable marketing insights. The authors could have provided stronger balance regarding available therapies, but those also weren’t the primary focus of the study.
Also, let’s give the physician audience a little credit. It’s not unreasonable to assume that most physicians are reasonably adept at interpreting studies and assessing their limitations. Plus, it’s unlikely that anyone is going to be swayed with just one data point to consider. Others, however, feel more strongly about this being an insidious assault by the evil drug marketers.
But consider some of the positive aspects of this study and subsequent discussion. It certainly adds to the body of knowledge about the conversations that occur between physicians and patients, an area worthy of further exploration. Also, regardless of what they think of the conclusions, by reading this article perhaps some physicians will become just a little more self-aware of how they communicate with their patients, an important step in changing their behavior. Finally, the well-intended efforts of others to point out limitations and correct misperceptions in the study have done a good job at raising awareness of the study and the underlying clinical needs.
So, before we put the final brick into the wall between academic purity and commercial interests, let’s make sure that we recognize that value can come from more than just statistically significant results and elegantly designed, objective studies.(Read full post)
The Body Mass Index (BMI) has long been the standard for assessing obesity as its simple, convenient and cheap. But it has also been dogged by complaints that it’s inaccurate and limited. A study in the journal Pediatrics suggests there might a more accurate measurement to assess obesity in children – neck circumference (NC).
Neck circumference could give a more accurate measurement of someone’s body fat composition than BMI, particularly in the all important spare tire area. NC has a strong correlation with central adiposity (fat around the middle), which studies have shown is a good indicator of obesity-related complications.
In the battle against obesity, more accurately measuring body fat composition is a big step in the right direction. But obesity management, and the management of metabolic diseases commonly associated with obesity such as type 2 diabetes, high cholesterol and hypertension are things we need to focus on now.
Through the use of behavioral science, we’ve learned that while the conditions varied, the motivations and barriers to change of patients diagnosed with those conditions are very similar. We’ve called this a “metabolic mindset”, and believe that if approached correctly, is susceptible to change.(Read full post)
There can be a tendency within the pharmaceutical industry—although I’m not pointing fingers—to sacrifice emotion and authenticity in communications for the sake of “playing it safe.” But, particularly in patient-facing communications, we must keep in mind that patients’ illnesses—whatever they might be—are indeed emotional issues for them. And for their families, friends and all of the others who care about them. So, in order for companies and their brands to authentically connect with patients, it’s essential—not optional—to find a way to tap into the emotions they’re feeling. Acknowledging them. Honoring them. And addressing them. All the while staying out of trouble with the folks up in the legal department.
For the purpose of today’s post—and to keep this from becoming a dissertation—let’s focus on how we communicate with patients through Web sites. At the SXSW Interactive conference last month, I was reminded (thanks to Kristina Halvorson, CEO and founder of Brain Traffic) that our arsenal for creating powerful Web site user experiences is larger and more powerful than ever. Among the tools we have for building compelling online content are:
And, within the subsets of these groups of tools are even MORE tools—like data visualization, metadata, user comments, error messages (yes—they, too, are part of the user experience and should be given careful thought), forms, links, search results, and a whole host of others.
Any and all of these tools, when used correctly and implemented with strategic consideration regarding their core purpose, can be used to create a genuine interactive experience with patients. And, notice I said “interactive.” A Web experience should never be static. The more back and forth there is between your brand and the user via the Web site—the more probable it is that a very real and lasting connection is being made.
In my opinion, Lilly is one of the pharmaceutical companies out there doing a really nice job of simultaneously recognizing and addressing both the informational and emotional needs of its audience. In the Diabetes TouchPoints section of LilyDiabetes.com, users are greeted by a video of Virginia Valentine. Not only is she a Certified Diabetes Educator, but she also has the disease herself. So, between that and the fact that she’s a natural on camera, the emotional connection with site users is immediate. And that’s the way it should work. Plus, she delivers relevant information in a very warm, conversational style that makes it feel like you’re sitting across from her in your living room.
Other features of Lilly’s site include an area for users to rate which content they find most useful, a Virtual Kitchen in which Chef Robert Lewis walks site visitors step-by-step through diabetes-healthy recipes and relevant downloadable educational materials for adult and pediatric patients, as well as for their caregivers. It’s evident that the entire Web-based experience was given careful and very deliberate consideration and that—at all times—the needs of the patient drove that process.
We have a lot of new Web-based technologies at our fingertips to enhance the age-old process of storytelling. A process that in and of itself has connected human beings for all time. While it can be a bit nerve-wracking for those whose role it is to keep us out of legal quagmires, there are ways to use these technologies that satisfy the needs and interests of everyone involved. We just have to have the creativity, commitment and patient-centered focus to implement them in ways that bring emotion and warmth back into what is all too often a very cold and sterile experience.(Read full post)