5 Ways to Help Your Cancer Patients Be More Compliant

Neil Chesanow

Disclosures

June 19, 2014

In This Article

Try a Promising Way to Get Through to Patients

The National Coalition for Cancer Survivorship charges that oncologists may inadvertently create barriers to communication with their patients. Among those cited are withholding information or giving it in "a cold, tactless manner"; raising your voice; talking down to patients; using medical terms that patients may not understand; discussing serious or personal matters with patient or family in a busy hospital hall or clinic waiting room; and belittling patients who ask questions that are important to them.[15]

A method of talking with patients has been developed that helps doctors avoid barriers such as these and focuses instead on eliciting the patient's barriers to compliance, so that they can be addressed. Called "motivational interviewing," the method was originally developed to facilitate behavioral change in alcoholics and drug addicts, but it has since been adapted to treat patients with a variety of chronic conditions, from cardiovascular disease to respiratory illness, diabetes, and cancer.[16]

Behavioral psychologist Kim Lavoie, PhD, Associate Professor at the University of Quebec at Montreal and Co-director of the Montreal Behavioral Medicine Centre in Montreal, Canada, has trained more than 7000 physicians and other providers in motivational interviewing techniques. The key to the method is partnering with the patient. One way you do this is to ask the patient's permission to discuss compliance issues rather than simply offering advice, she says.

Patients who are given the opportunity to grant permission have a greater emotional stake in what is then said, Lavoie asserts. Everything else about the method is built on this partnership.

"Rather than say, 'I think it's time to try a new medication' -- what we call 'prescribing change,' saying, 'Do this, do that' -- this is really a motivational alternative to that," Lavoie explains. "Instead of saying, 'Here's my opinion,' you'd say, 'May I give you my opinion? Would you like to know what I think about this situation?' So it's really avoiding telling patients what to do and encouraging them to generate their own solutions for their problems that are challenges."

"If there's resistance to the information that's discussed, then you want to explore the patient's ambivalence about or resistance to change," Lavoie says.

You do this by asking open-ended questions that encourage reflection and insight in the patient: for example, "How would your life be different if you weren't doing X?" or "What would you need to change to achieve your goals?" You would then respond by expressing empathy and asking the patient, "What do you need to succeed?" and "How can I help you?" Lavoie says.

Motivational interviewing includes a variety of concepts and tools, and the number of different situations with noncompliant patients in which to use them is vast. To get good at this, some training is recommended. There are live workshops; online courses, often for CME credit; Webinars; podcasts; training videos; journal articles; textbooks -- you name it. A Google search will turn them up.

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