September 15, 2020

Consider how hard it is to change yourself and you’ll understand what little chance you have in trying to change others. ” – Jacob M. Braude

Mr. Smith has just gotten a new prescription for his newly-diagnosed diabetes and is getting it filled at his local pharmacy. The pharmacist has known Mr. Smith for years and asks him how he’s doing with the new diagnosis. Mr. Smith explains, “I know the doctor told me I need to change my diet and exercise, but I think I’m just going to take this pill — I don’t want to change my diet.” What would you say next if you were his pharmacist? For many of us, we have this irresistible urge to persuade Mr. Smith until he agrees to adhere to what his doctor recommended. But, is this really the best approach? Or, should we try something different?  What’s in the best interest of the patient?

Motivating Changes in Health Behaviors

Think about the last time you made a change. Why did you start the change? It could be something you read, or a friend told you, or an event, such as the start of a new year. Typically, there was a reason for achieving that goal, a goal you wanted to achieve, and a belief that you could do it! Chances are you didn’t make the change simply because someone told you to change. It’s a natural human instinct to resist persuasion.  Just like us, patients can find it harder to change when challenged. Instead, there are other ways to help our patients make the changes they need for their health, like motivational interviewing (MI).

MI is a patient-centered communication approach that focuses on working with a patient finding their motivation, or their reason, to make a change. The four main principles used in MI are:

  • Reflective listening (repeating back what the patient says)
  • Expressing early empathy (making sure to show care and concern for what the patient is going through)
  • Rolling with resistance (having the patient explain more about why they don’t want to change)
  • Developing discrepancy (examining with the patient the difference between their goals and their behaviors)

It’s a natural human instinct to resist persuasion. Just like us, patients can find it harder to change when challenged.
Healthcare providers who are trained in MI spend more time listening instead of talking and understanding instead of persuading.  A healthcare provider who uses MI helps patients think through why they should make changes, what goal they should set, and how they might accomplish it. To do that, the healthcare provider spends time asking the patient thought-provoking questions and listening to their thoughts and beliefs regarding health behavior changes. Often, the changes that the patient decides to make are a collaboration — changes the patient is willing to make with guidance from their pharmacist, physician, or other healthcare provider. Research has found that when providers use MI, patients are more likely to improve their health by quitting smoking, attaining healthy body weights, increasing their physical activity, and improving their self-management of chronic diseases, such as diabetes. At Cedarville University School of Pharmacy (CUSOP), we have had a research project that examined the impact of MI on pain management and decreasing opioid use and currently are working on a project to improve pediatric vaccination rates through MI.

Building Relationships to Drive Changes in Health Behaviors

At Cedarville University School of Pharmacy, we want our students to build relationships with their patients and collaboratively engage them in decision-making. That’s why we train all of our students in MI. Just as we tell our students, it is important to remember that the patient will ultimately decide whether or not they want to change.  By using MI, however, they can build a long-lasting relationship with a patient by showing them that they truly care about them by listening and sharing in decision-making.

Let’s go back to Mr. Smith.  If the pharmacist pauses and says in response, “Change is hard! I think it’s great that you are going to take your new medication. I’d love to talk with you a bit more about your diet. Can you tell me what you know about how your diet impacts your diabetes?”… don’t you think that just might open up an opportunity for change?

 

Aleda M. H. Chen, Pharm.D., M.S., Ph.D., FAPhA is the Interim Dean and an Associate Professor at Cedarville University School of Pharmacy.  Dr. Chen’s interests include patient health behavior change and finding ways to best educate student pharmacists and patients.

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