HEALTHCARE
September 5, 2018

When Doctors and Patients Collaborate

Patients are more likely to take the necessary steps to improve their health if their doctors ask them what is and isn't working for them.

Even though most of us know what it takes to be healthier, we often still find it hard to do so. Needless to say, this is frustrating for doctors who counsel their patients about lifestyle changes that can help them avoid health problems, only to find that patients are resistant.

If doctors try to educate patients by talking at them rather than with them, it rarely translates into consistent behavioral change. Simply telling patients what to do doesn't work nearly as well as a conversation with patients about what they see as the obstacles preventing them from changing to a healthier behavior.

When patients tell their doctor what could work for them, they are more likely to follow through because they, not the doctor, came up with the solution.

This kind of collaborative approach lets doctors make suggestions and provide information patients are likely to use, because it’s tailored to what they need. “Providing information to patients does not change behavior as effectively as trying to understand their point of view,” Kimberly Mallett, lead author of a study focused on improving sun protection behavior, told TheDoctor.

Dermatologists often tell their patients about the right way to use sunscreen and remind them to wear protective clothing. But not all patients listen. Mallett and her team developed a short intervention dermatologists can use to talk to patients about how they might protect their skin and be more sun safe. The program is less than three minutes.

Called the Addressing Behavior Change (ABC), the intervention measures patients’ risk of sun exposure and their willingness to use sunscreen and other sun protection methods. It also asks patients to describe what prevents them from protecting themselves from the sun, and how they think they can overcome these barriers. Their answers make it possible for their doctors to offer alternative ways to reduce exposure to the sun.

Doctors might ask patients about what they do to protect their skin from the sun, if they had a sunburn in the past year, or if they like to be outdoors, to get a better sense of any difficulties patients have with sun safety. Patients are asked to rate, on a scale of one to 10, how willing they are to use sunscreen.

If patients say they are at a seven, it suggests they might not like something about sunscreen use, said Mallett, a research professor at Penn State. That may lead to a follow-up question about exactly what it is they don’t like. Once patients specify what that is, doctors have an opportunity to ask them what they might do about it. When patients tell their doctor what could work for them, they are more likely to follow through because they, not the doctor, came up with the solution, Mallett added.

The ABC approach encourages patients to explore different solutions with their doctors and gives the doctor a chance to offer a menu of options. In terms of sun safety, options might include trying different formulations of sunscreen or wearing sun protective clothing. “Using the ABC intervention lets the patient leave the visit with tangible ideas they can implement,” said Mallett.

Over 150 patients were assigned to receive either the ABC intervention at a dermatologist visit or be part of a control group who received standard sun protection education. Those who did not receive the ABC intervention reported almost twice as many sunburns at a one-month follow-up compared to those who took part in the ABC collaboration. People in the ABC group reported more sunscreen use over the three months of the study compared to those in the control group; they also rated communication with their dermatologist more highly than those in the control group.

The study appears in JAMA Dermatology.

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