Simple Tips for Discussing Goals of Care with Patients

Simple Tips for Discussing Goals of Care with Patients

Many seasoned transitional care coordinators recognize that a care plan should consider the personal motivators that encourage patients to take an active part in their recovery. To identify those unique triggers, it helps to apply a patient-centered approach that is rooted in motivational interviewing.

The aim of this approach is to dig in and find out what drives the patient to action. Once they have that information, transitional care teams can then align the care plan goals with the life goals of the patient in order to achieve lasting results in terms of treatment and improved health outcomes. For example, instead of simply instructing patients to adhere to their medication regimen, a motivational interviewing tactic would be to persuade patients to take responsibility for their own medication management by pointing out key benefits such as a sense of personal empowerment and continued progress toward recovery.

Below are the four primary guiding principles of motivational interviewing.

  1. Resisting the “righting reflex”: Simply put, medical staff should resist the urge to admonish wrong or inappropriate behavior without helping patients understand why the behavior is unsuitable.
  2. Exploring and understanding the personal motivation of patients: Getting to know your patients can go a long way toward identifying what drives them to action.
  3. Listening with empathy: When patients feel they are truly being heard and understood, they are more likely to respond positively.
  4. Empowering patients and encouraging optimism and hope: Remind patients that they have the power to influence their well-being and that every small step toward recovery is a positive one.

For transitional care professionals who want to apply motivational interviewing tactics when communicating with patients, we offer these simple suggestions:

  • Earn their trust. The key to success is in the trust of your patients. In order to earn that trust and encourage them to open up, demonstrate your empathy and genuine interest. You can do this very simply by starting a conversation and asking patients what they do at home, who they enjoy spending time with, and similar personal questions.
  • Find out what exactly they want. Begin with questions such as, “What do you hope to achieve?” or “What are you worried about?” For example, if you know a patient’s personal goal is to obtain a high school diploma, you can ask the patient what is standing in the way of that goal. Answers to questions like these will help you determine if there are any health issues preventing patients from accomplishing their goals.
  • Avoid telling patients how to achieve their goals. Instead, focus on helping them come up with their own plan by asking the right questions.
  • Gently point out inappropriate or destructive behaviour. One of your main tasks as a health care provider is to help patients understand that such behaviour will not support their life goals. When they realize the problems and risks associated with destructive behaviour, they are more likely to change that behavior.

Treatment of any disease is always a collaborative effort between health care providers and their patients. It is not possible to achieve clinical outcomes without the strong desire and motivation of the patient based on the opportunity to accomplish his or her life goals.

Therefore, one of the fundamental aims of transitional care teams is not only to diagnose a disease and choose an appropriate treatment, but also to help patients to stay motivated and engaged in the treatment process. These simple tips can help you and your patients stay on the path to success.

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