Patient Education and Skill Building

Patients and families need clear information to understand the signs and symptoms of the disease(s) and treatments, and training to build the skills to monitor clinical indicators such as glycemic control or peak flow volume. This clinical content distinguishes self-management education from self-management support, which helps people make behavior changes and sustain them over time. Physicians, nurses, or other clinicians with appropriate training can provide self-management education. Primary care teams may have difficulty finding time and appropriate staff to provide patient education sessions in the course of an office visit, but providing just the right information in response to patient needs or questions is a very effective way to incrementally increase their understanding and skills. For in-depth education, programs offered by public health entities or hospitals are an underused referral resource. Psychosocial and emotional stressors as well as physical symptoms should be considered in these programs.

Goal Setting, Action Planning, and Problem Solving

Helping patients know what to do to stay healthy is important, but the goal of self-management support is to help them adopt the behaviors that will keep them healthy over time. Motivating and coaching healthy behaviors is one method of supporting self-management that can be done very effectively by non-clinicians. By developing skills through training and practice, tasks required to support patients and familiessuch as making a specific plan of action, anticipating barriers, and connecting them with community resourcescan be the responsibility of members of the care team other than the physician, often with equivalent results.

For patients with chronic conditions, setting health goals with the help of a physician is an important step, but few patients achieve goals without more specific planning. Additional behavior change coachingspecifying action planning steps and anticipating barriersis needed to develop patient confidence in reaching goals. Medical assistants, nurses, nutritionists, behavioral health professionals, health educators or trained lay people, if trained in action planning and problem solving strategies, can effectively work with patients to define their action plans.

• Assist the patient in completing an Action Plan form and give them a copy to take home.

Setting Healthy Goals

Studies show that patients rely on physician advice in determining health goals. Collaboratively setting health improvement goals with patients is an important step in motivating healthy behaviors. Physicians or other providers set treatment priorities and make recommendations about changes that would enhance health. To be effective in engaging the patients and families toward healthy behaviors, physicians will also ask about patient concerns and priorities, and then they will collaboratively arrive at a plan for self-management.

Using agenda-setting tools such as the Bubble Diagram can introduce the collaborative process of establishing healthy goals. It is important that patients’ priorities in goal setting lead the decision about which goals are established. Keep in mind that achieving small successes toward a goal that is important to patients will enhance their confidence and sense of control in managing their illness, and this will pave the way to achieving goals in other areas.

• Use a variety of tools such as the Bubble Diagram or Dinner Plate Menus to engage the patient in setting a health goal.

Sharing Information

One of the most important roles of clinicians is to provide information, including answering patients’ questions about a disease or its symptoms, interpreting clinical data or lab results, and explaining the appropriate use and methods for taking medication. Information about the illness, symptoms, treatment, and medications is central to patients’ ability to manage well, but information alone is not enough. The goal in sharing information for self-management support is to ensure that patients not only understand but are also prepared to act on the information in daily life.

Of course, telling patients what they need to know is not a guarantee that they will be able to use the information, and conveying all critical information during a short visit may not have the desired outcome if patients are not able to understand and use it.

. Share clinical information based on patients’ lab or other screening values and interpret that information to connect their understanding of how healthy behaviors keep clinical indicators in range.

Coping with Stress and Negative Emotions

Clinicians are rightfully focused on the clinical indicators and outcomes of chronic illness care, but for patients and families the central experience of chronic illness is often one of physical limitation, loss of function, and uncertainty in daily life. The fatigue and stresses of the disease and adapting life roles to accommodate changing capacities generate emotional responses that make a huge impact on the ability to self-manage. When clinical teams recognize this difference of perspective and acknowledge the everyday burden of illness and negative emotions (anger, fear, frustration) that so often accompany managing chronic diseases, patients and families feel heard and understood and are more willing to collaborate with clinical teams.

Over time, these interactions support the collaborative relationship that helps patients become more active managers of their health and keeps them going during challenging times. Sometimes the psychosocial burdens require help from behavioral health specialists. Care visits that regularly utilize depression screening questions such as the Patient Health Questionnaire 2 can ensure that those who need more intensive help will be identified.