Supporting Self-Management in Chronic Disease
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Transcript of Supporting Self-Management in Chronic Disease
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Michael Vallis, PhD, R Psych
Psychologist and Lead, CH Behaviour Change Institute
Associate Professor, Dalhousie University
Halifax, CANADA
Supporting Self-Management in Chronic Disease
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2
What, Me Judgmental?
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What is the Standard of Care?
•Dominant models of behaviour in health care
•After giving rounds to dialysis/transplant team I was cornered by several staff
• “You work in the diabetes centre, right? We need you to take a message to the staff”
• You don’t talk enough about complications
• Our patients say: “if I knew my life would be this bad I never would have let my diabetes stay out of control”
•After giving a talk on behaviour change a family physician said
• “The problem is we just don’t scare our patients enough. If we put the fear of god into them they would do what we say”
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25
DAWN2% of people with diabetes and health care professionals reporting their health care team/they engage in each behavior most of the time or always
N = 4,785
N = 8,596
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Establishing
Change-Based
Relationships
Readiness:
How to Assess
How to Enhance
Supporting
Behaviour
Change
Reduce
Risk of
Relapse
Effective Self
ManagementInterventions
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Outcomes aredependent on how goodyou are
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• Fundamental change in the relationship between the individual and the HCP
• From
• Expert clinician with uninformed helpseeker
• “Let me tell you what you need to do”
• “Let me tell you what you need to know”
• To
• We both have a role to play
• “I understand that you will make your own decisions and I respect that. Can we have a conversation about your health”
Interpersonal Dynamics
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•What do patients want?•To minimize the impact of diabetes in their life •This often means avoiding the tasks
•What do providers want?•To get the recommended glucose (A1c) and bp control•This means using lifestyle, medication and insulin
Interpersonal Dynamics
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More Recipe for Disasterthan Match Made in Heaven
Therapeutic Alliance
Interpersonal Dynamics
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Interpersonal Dynamics
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Series1
Change-Based
Relationship
Motivational Enhancement:
Getting to Behaviour
• Is the behaviour (or lack of it) a problem for you?
• Does the behaviour (or lack of it) cause you any distress?
• Are you interested in changing your behaviour?
• Are you ready to do something to change your behaviour now?
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Getting to the BehaviourReadiness Assessment
Not ReadyReady
Go Right to BehaviourModification
Ambivalent
Understanding the behaviour•Personal meaning
•Seriousness, personal responsibility, controllability, optimism
Expanding on readiness•Personal/meaningful
reasons to change
•Willingness to work hard - connect to principles
•Delay of gratification
Barriers/TemptationsEspecially social, cultural and environmental
Decisional Balance
Self-Efficacy
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Series1
Change-Based
Relationship
Motivational Enhancement:
Getting to Behaviour Behaviour Modification
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Series1
Change-Based
Relationship
Motivational Enhancement:
Getting to Behaviour
Behaviour Modification
Emotion Management
Assess and address the 4 SsSelf-image
Explore if the behaviour is internally of externally motivatedSelf-efficacy
A person’s confidence to perform a specific behaviour in a specific context for a specific time period and in the face of specific barriers
Social SupportAre there external factors that help sustain the behaviour?
StressIdentify emotional issues and search for opportunitiesto replace the function of unhealthy behaviourIdentify and encourage stress managementLink stress management to adherence, participation
• It is not Psychotherapy
• Your role is best delivered in the following manner:
• Identify and label
• Educate
• Recommend
• Support
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THAT’S ALL: THANK YOU!
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www.behaviourchangeinstitute.ca
www.improvingdiabetescare.com