How to change your world? - Cancer Research UK · PDF fileHow to change your world? ... Share...
Transcript of How to change your world? - Cancer Research UK · PDF fileHow to change your world? ... Share...
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How to change your world?
Dr Richard Roope RCGP & CRUK Clinical Lead for Cancer
Wessex Cancer CSN GP Lead
Macmillan GP
RCGP/CRUK Cascade Workshop
October 23nd 2014
Birmingham
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How to change your world…
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How to change your world…
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How to change your world…
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Who is in your world…
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Who is in your world…
• Who can GP Leads influence?
• Who can you influence
• 5 minutes in pairs…
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Who is in your world…
• Who can GP Leads influence? • GPs – Primary Care engagement
• Cancer SCN Clinical Directors
• Area Teams MDs and ADs
• CCGs/NHSBs/HBs
• PHE (including screening hubs); NHS Health Scotland; PHW
• HWBs/LAs
• Hospital Trusts – “SSGs”
• Educators – Medical School, GP Trainers, First 5 groups, RCGP Study Days, Appraiser Trainers
• Public/Patients
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How can we influence?
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How can we influence?
• How will you influence…
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How can we influence?
• How will you influence…
• Four common solutions:
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How can we influence?
1. Share insight – then they will see…
2. Share knowledge – then they will know…
3. Share skills – then they will act…
4. Scare them – then they will change…
After Miller WR (2004)
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How can we influence?
• Exercise 1
• In pairs – one will be the Primary Care Cancer Lead
one the SCN Assistant Director
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How can we influence?
• In pairs – one will be the Primary Care Cancer Lead
one the SCN Assistant Director
• Cancer Lead – explain why Cancer Rehab should be adopted
• Explain why it should be
• Give three benefits
• Tell them how important this would be
• Persuade them to implement the scheme
• If they resist repeat even more persuasively…
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How can we influence?
• SCN Assistant Director
• How did it feel?
• Did you agree to anything?
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How can we influence?
• The Righting Reflex
• We have a desire to put things right – we want to make things better
After Miller WR and Rollnick S (2006)
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How can we influence?
• The Righting Reflex
• Problem:
• People have a tendency is to resist persuasion especially when ambivalent
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How can we influence?
• The Righting Reflex
• The approached feel invalidated:
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How can we influence?
• The Righting Reflex
• The approached feel invalidated:
disconnected
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How can we influence?
• The Righting Reflex
• The response:
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How can we influence?
• The Righting Reflex
• The response:
unchanging
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How can we influence?
• The Righting Reflex
• The consequence:
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How can we influence?
• The Righting Reflex
• The consequence:
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How can we influence?
• Exercise 2
• In pairs – change roles:
one will be the Primary Care Cancer Lead
one the SCN Assistant Director
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How can we influence?
• Evoking/listening exercise:
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How can we influence?
• Evoking/listening exercise:
• Listen carefully – give no advice. Ask these questions:
1. Why would you want to provide a Cancer Rehab service?
2. What would be the three best reasons to adopt this policy?
3. On a scale of 0-10 how important would it be to adopt this policy? Why are you at … rather than 0?
4. How would you implement the policy?
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How can we influence?
• SCN Assistant Director
• How did it feel?
• Did you agree to anything?
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How can we influence?
• Evoking/listening:
• The approached feel affirmed:
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How can we influence?
• Evoking/listening
• The approached feel affirmed:
optimistic
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How can we influence?
• Evoking/listening
• The response:
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How can we influence?
• Evoking/listening
• The response:
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How can we influence?
• Evoking/listening
• The consequence:
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How can we influence?
• Evoking/listening
• The consequence:
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How can we influence?
• Success ≠ Change – you do not need to evoke a commitment to change – you may not be able to…
• You do not have to have all the answers – you won’t have them
• You are not involved in combat – you would probably lose. It is more of a dance…
• Our role is to invoke the desire to change
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How can we influence?
• Motivational Interviewing:
• Other centred
• Directive Method
• Aims to enhance motivation to change by addressing other’s ambivalence
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How can we influence?
• Four principles: R-U-L-E
1. Resist the righting reflex
2. Understand the other’s motivations
3. Listen with empathy
4. Empower the other – encourage optimism and hope
After Rollnick, Miller and Butler – (2008)
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How can we influence?
• Four skills: O-A-R-S
1. Open questions
2. Affirmation
3. Reflective listening
4. Summarise the discussion
After Amrhein (2003)
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How can we influence?
• Four steps to change: D-A-R-N
• Desire: “It would be nice to…”
• Ability: “I could…”
• Reasons: “I have got to because…”
• Need: “I am definitely going to…”
• COMMITMENT: “I will/know/guarantee…”
After Amrhein et al (2003)
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How can we influence?
• Change talk:
• Change occurs when people persuade themselves..
• Change stalls (if it ever started) when we attempt to persuade, force, pressure..
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How can we influence?
• Change talk:
• Once you recognise it reinforce the “change talk”
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How can we influence?
• Practise
• Supporting/supportive community
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Key to change