Chronic disease prevention is a critical aspect of patient care at all risk levels, but becomes particularly important when a patient moves into rising risk. When that happens, clinicians need to employ targeted patient communication strategies to drive patient engagement with key lifestyle and healthy behavior changes.
Those patient communication strategies should be varied and tap into individual patient motivations. Through strong patient education, shared decision-making, motivation interviewing, and empathy, clinicians can coach their patients through chronic disease prevention with the ultimate goal of staving off illness.
One of the first steps to any patient engagement endeavor is offering strong patient education. After all, a patient doesn’t know what she doesn’t know, and it is far more difficult to engage with her health when she doesn’t understand it.
Healthcare providers should lean on patient education strategies during patient communication and chronic disease and preventive care.
According to the Centers for Disease Control & Prevention, the qualities of good patient education include:
- Teaching of functional health information, or essential knowledge about one’s health
- Shaping of personal values to support personal health
- Shaping of group norms that support personal health
- Development of personal skills to help maintain personal health
In the clinical encounter, healthcare providers should stay mindful of patient health literacy levels, English language proficiency, and cultural norms that could influence a patient’s ability to not just understand health information, but apply that information into their everyday lives.
The question of health literacy and English language proficiency, although complex to account for, follow basic logic. A patient cannot benefit from patient education efforts if the information provided is not understandable (most experts recommend information at a fifth grade level) or in a language the patient can understand (provider offices should offer materials in other languages and look into interpreter solutions).
But cultural competency and responsiveness can add an extra foil to patient education and health advice. A patient might have dietary considerations as they relate to her culture that education and health advice should account for, lest the patient forego all health advice and lose trust in her provider at the same time.
Cultural competency does not mean a provider knows everything about every culture; instead, it means she can appreciate, consider, and respond to different cultures in her medical practice. By working in tandem with her patient, that provider can deliver education and ultimately health advice that could improve patient well-being and drive chronic disease prevention.
The work the provider does in tandem with the patient is called shared decision-making and is a key patient communication strategy. Once a provider identifies a patient is rising risk for a certain chronic illness, it would behoove her to engage in shared decision-making with her patient to determine feasible lifestyle changes and interventions.
Shared decision-making begins with the above-mentioned patient education. Some healthcare organizations employ physical or digital decision aids that tell patients about the different care options available to them and the likely results of each.
When employing shared decision-making, the Agency for Healthcare Research & Quality (AHRQ) suggests providers use the SHARE approach:
- Seek your patient’s participation
- Help your patient explore and compare treatment options
- Assess your patient’s values and preferences
- Reach a decision with your patient
- Evaluate your patient’s decision
Ultimately, shared decision-making should result in a medical or lifestyle choice that both the provider and the patient can own. In chronic disease prevention, that means the patient could be more likely to follow through with the lifestyle change, ideally staving off the illness for which the patient is rising in risk.
But there have been some challenges to shared decision-making, most notably as it relates to time. In the past, clinicians have said they don’t have enough time to do full shared decision-making, leaving them to sometimes prescribe a preventive measure instead of working with the patient to identify a reasonable lifestyle change.
Time constraints may be less of a worry now, as more primary care providers switch to patient-centered care models and value-based reimbursement incentivize good results—and good patient engagement—over volume.
Providers still feeling a time pinch could try appointment agenda-setting, engaging the patient before the encounter about what the patient wants out of the visit. The clinician can then plan the visit based on important items she wants to hit—chronic disease prevention—and work them into the topics the patient wants to cover.
In addition to shared decision-making, motivational interviewing can help clinicians get at the heart of what will compel a patient to make a healthy behavior change. While shared decision-making gives a patient a stake in the health intervention or lifestyle change, motivational interviewing will help providers uncover what will push the patient to follow through.
Usually, that’s a non-clinical factor, like wanting to live to see grandchildren graduate or wanting to keep playing pickup basketball.
“[Motivational interviewing] is a method for changing the direction of a conversation in order to stimulate the patient's desire to change and give him or her the confidence to do so,” the American Academy of Family Physicians (AAFP) says on its website.
“In contrast to many other change strategies employed by health care professionals (such as education, persuasion and scare tactics), motivational interviewing is more focused, goal directed and patient centered.”
Clinicians engaging in motivational interviewing should use open-ended questions, affirmations rooted in clinician empathy, and reflective listening that uses the patient’s own language. Clinicians should conclude with a summary of what the patient said to ensure both the clinician and the patient are on the same page about patient goals.
AAFP advocates the following principles during motivational interviewing:
- Motivation to change is elicited from the patient, not imposed from outside
- It is the patient's task, not the physician's, to resolve his or her ambivalence
- Direct persuasion is not an effective method for resolving ambivalence
- The counseling style is a quiet one, with a focus on eliciting the patient's thoughts
- The physician is directive in helping the patient examine and resolve ambivalence
- Readiness to change is not a patient trait but a fluctuating product of interpersonal interaction
- The therapeutic relationship is more like a partnership or companionship; expert/recipient roles can impede the process
Central to motivational interviewing is understanding the patient's point of view. After all, the patient and the provider both likely want the patient to get healthier, but the patient may prioritize other factors in that journey. That means motivational interviewing must be supported by strong clinician empathy.
In some cases, preventive care might be something a patient does not want to engage in. For example, vaccine hesitancy keeps patients from getting any number of inoculations, including the flu shot. Vaccine hesitancy also keeps some parents from adhering to the childhood vaccine schedule.
It will be critical for healthcare providers to understand the root of a patient’s hesitance, and in many cases that root is fear.
In July 2021, researchers wrote in JAMA Pediatrics that most parents refuse the HPV vaccine for their teens because they are worried about safety. Per the data, the rate of parents refusing the HPV vaccine out of fear rose 7.6 percent between 2008 and 2015; in 2015, 12.9 percent of parents opted out of getting their kids the shot because of patient safety concerns.
Although potentially frustrating—especially given the role social media misinformation plays in fomenting vaccine hesitancy and fear—healthcare providers need to approach these parents with empathy.
“We understand that patients may have had real experiences of perceived harm, or real harm, from prior treatment or vaccines,” Dan Slater, MD, Atrius Health’s chair of pediatrics, said in a 2019 interview with PatientEngagementHIT. “They may have family members with disease states where they have a belief or perception that the vaccines were involved. They may be misinformed. They may think something might be true and it's an opportunity for providing some up to date education and information. It's most important for pediatricians to inquire about what their concerns are and see where that's coming from.”
From there, healthcare providers can tailor patient communication strategies to specific patient and family needs. Importantly, this could keep the patient or parent from feeling attacked or belittled, and could be more productive at actually generating engagement with preventive care.
And it’s that very preventive care that will go all the way to ensuring a healthier population going forward. Keeping patients from contracting illness in the first place, and then potentially experiencing long-term symptoms like some scientists are seeing with long-COVID now, is a good first step.
And when a patient does move into a rising risk category, using further empathic communication techniques like shared decision-making and motivational interviewing can help patients adopt key lifestyle changes that could keep further chronic disease at bay.