In order to develop consultation skills effectively we need to evaluate the way that we practise as an individual; to let go of advice giving and let the patient take charge (33,35).
Before we can practise differently we need to examine the way that we currently practise.
We need to examine our own preconceptions first, and over time develop a less judgmental approach to our care.
This means that behaviour change takes time both for the professional and the patient.
Rollnick et al. (21) state that all models of education are only as effective as the practitioners who use them.
A review of their study on behaviour change in 2000 showed the model of education used, wasn’t as effective as anticipated, as the professionals found it hard to change their behaviour and therefore lapsed into a previous consultation mode.
Encouraging patients to make their own decisions and to set their own targets was harder than anticipated, especially when good diabetic control was not being achieved.
This posed a number of questions, one of which was ‘Do we need to reconsider the issue and extent of professional responsibility?’ Further, ‘Do we aim for the change in patient behaviour that the professional wants or facilitate informed choice by the patient?’ Not all professionals will behave in the same way, and patients’ perceptions of their condition, their coping strategies and the implications of these on their long-term health status, will also vary considerably (36).
So although we may think that we have encountered a situation before, the solution will always vary as the patient’s needs and drive will be different.
More research is needed into professional perspectives on chronic care, the strategies used by professionals to manage patients and to cope with their own feelings, and the implications of these strategies for patients (16,37).
If you are trying to change your behaviour to enable you to work more effectively with patients, you need to constantly review the process.
It will continuously evolve over time, and within the educational models you will adapt and find certain aspects that work best for certain patients , this is not a process set in stone.
It does, however, require a core set of basic counselling skills, as all models require the application of these during their use.
Videos of consultations and case reviews are an effective way to enrich and develop your practice and that of others.
In Doherty’s study in North Shields the most valuable training methods were individual supervision and
42 NUTRITIONAL MANAGEMENT OF DIABETES MELLITUS
video examples. Videos of consultations can be used as a teaching aid to illustrate certain techniques or as a way to assess current practice. Reflective practice is a vital part of personal development. This is essential in developing and supporting practice, as perceived and actual communication can vary (37). You could use the following questions at the end of a consultation to reflect on your practice:
How much was I able to accomplish by just asking questions? .
Was I tempted to jump in with advice and solutions? .
How did the patient respond to my questions? .
Was the session effective? .
Who did most of the talking? .
Did the patient express any concerns with regard to their diabetes and management, and were these acknowledged? .
Who set the agenda? .
Who set the goals? .
Did I listen? .
Do I feel that I understood what motivates the patient? .
Do I know how confident the patient feels to follow through the changes discussed? .
Do I know how competent the patient feels to follow through changes and the impact this will have on their life?
Giving patients a greater role in the management of their own condition corresponds to current views stressing the importance of being more patient- centred and developing an equal partnership with patients with a chronic illness.
There is work starting to emerge that suggests behavioural counselling leads to improvements in healthy behaviour.
It suggests that extended counselling to help patients sustain and build on behaviour changes may be required before differences in biological risk factors emerge.
On the whole behaviours change simply, and it may be unrealistic to expect people to embrace a consistently healthy lifestyle in one fell swoop.
Patient-centred empowerment and behavioural problem-solving skills training interventions produce results superior to both usual care and more traditional knowledge- based diabetes education (39).
Interventions that help facilitate self- management have been proven to be effective, and sometimes even cost- effective (40).
There is still a need to provide additional strong data to support this work, as many educational models support its ideology but the evidence is sometimes lacking (41,42).