Less than 20% of healthcare providers take such a moment to have this conversation
As a professor of Population Health at the LUMC, Jessica Kiefte conducts research into lifestyle and behavioral change in a broad context. She focuses, among other things, on the concept of the teachable moment: the right moment to talk to the patient about his or her lifestyle. “Students sometimes wonder: am I allowed to ask these questions? But with the right questions at the right time you can go much further.”
Jessica Kiefte can remember another example of what not to do. “A patient who was brought to hospital with an acute myocardial infarction was immediately asked in the emergency room whether it was the right time to stop smoking. Of course, that doesn’t happen at all, such a patient is still in full stress and tension. That is absolutely not the right time for such a conversation.”
What is the right time? “This could be a follow-up check, where the medical specialist has time to have another conversation. The doctor can then ask what this situation has done to the patient, how he feels now. That can make the patient think.”
Teachable window
Research shows that there are various ‘teachable moments’, although Kiefte prefers to speak of a ‘teachable window’: a number of moments when the patient is receptive to a conversation about his lifestyle. These are the moments after a deterioration in health, for example when a (chronic) illness is diagnosed, or when new medication is needed for the first time. Other important milestones in life, such as pregnancy or the illness or death of a loved one, can also be teachable moments.
Kiefte: “We always suspected that patients feel vulnerable at the moment and are therefore open to change. But it turns out to be something else; Research we have done on people with cardiovascular disease shows that after such a diagnosis they view themselves and their role in society differently. Suddenly they start thinking about how they can best shape their new role. This realization is an important starting point for the healthcare provider to continue discussing the patient’s health and what he or she can do about it.”
Unfortunately, this appears to rarely happen in practice: less than 20% of healthcare providers take such a moment to have this conversation. “And often too much is played on emotions such as fear of recurrence and the risks the patient runs. That could really be different.”
Course
It is understandable, says Kiefte. A large number of current healthcare providers are still trained in the old system, where the medical aspect of the condition is central. “They have only learned to a limited extent to see the patient from the full spectrum and to ask questions.”
This questioning is important; Sometimes there are reasons why a patient has an unhealthy lifestyle, then it is good to discuss this. “If you have major financial problems, you don’t have the mental space to think about your own lifestyle. You can only find this out if you, as a healthcare provider, keep asking questions. And you actually have to learn that early in medical training.”
The professor therefore advocates changing the curricula of courses at all levels. “A change is already underway within the study of medicine: the training framework already pays more attention to prevention and a broader view of the patient. This could also be implemented in other courses.”
Kiefte sees that the younger generation of healthcare providers is already asking patients different questions. “They look broader than just the medical aspect.” At the same time, there is still a lot of reluctance: “They wonder whether they are allowed to ask these questions, whether they are allowed to interfere in the patient’s private domain. But by practicing a lot with different conversation techniques, things get better and better.”
GLI
An important development is that there are more and more referral options for patients who want to work on their lifestyle. “Many hospitals now have a lifestyle care desk where there is time and space to discuss further with the patient.”
The patient can also be helped in other ways. For example, healthcare providers from the Heart Disease department at the LUMC have been able to register patients for a Combined Lifestyle Intervention (GLI) for some time now by connecting lifestyle coaches in the region. The GP is properly informed about this and there is direct contact with a lifestyle coach. “This was relatively easy to arrange, by making good agreements with each other. With small steps we can guide the patient towards a healthier lifestyle.”
Source: NFU
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