Lifestyle changes are often an important part of a patient's treatment or disease prevention plan. Talking to a patient about changing habits could improve quality of life, but unfortunately, for a variety of reasons, patients may not follow instructions. Some studies have estimated that anywhere from 25 to 50 percent of patients don't follow their doctor's orders.
Forming a Better Understanding
In order to ensure patient follow-up of suggested lifestyle changes, it's important to identify the obstacles that might prevent patients from making those modifications. The first is simply a lack of understanding about what he or she is supposed to do. A study titled "Strategies to Enhance Patient Adherence: Making It Simple," in Medscape General Medicine, found that at least 50 percent of patients leave their doctor's office unsure of what they have been told, suggesting that a major barrier to adherence is simply a lack of understanding.
One way that you can ensure better understanding is to simplify the treatment regimen. A patient will be more likely to remember to take a pill once a day or before a meal than to take a pill every six hours. Using simple, everyday language and having the patient repeat the instructions can also help foster a better understanding and adherence to instructions. It may also be helpful to limit these instructions to three or four major points and supplement any oral discussion with written material.
Another reason that patients may not follow their treatment plan is that they are creatures of habit. A study published in the Scandinavian Journal of Primary Health Care found that a majority of physicians and nurses agreed that patients' unwillingness to change their habits was a major barrier to the treatment of lifestyle-related diseases such as high blood pressure and diabetes.
If a patient is unwilling to make lifestyle modifications, you should remember that change happens gradually, not all at once. An article published in the journal American Family Physician suggests a Stages of Change model to help patients change their behavior:
- Precontemplation stage: The patient does not consider changing. They may be in denial or may have given up trying to change after failing in the past.
- Contemplation stage: The patient is ambivalent about changing and assesses the barriers and benefits of lifestyle modification. Although you can and should advise patients about the benefits of making changes, ultimately, they must come to the decision to change on their own.
- Preparation stage: The patient prepares to make specific changes and may experiment with small changes as their determination to make modifications increases.
- Action stage: The patient follows through with making lifestyle changes. At this point, it's important for you to praise any action taken by the patient because it shows a desire to change. You should continue to assert that the patient is responsible for achieving the goal. Doctors can better affirm and support patient goals by actively listening to patients' strengths and aspirations and providing positive reinforcement.
Following the action stage is maintenance and relapse prevention, which involves incorporating the new modifications over the long term. While the patient may be discouraged if they falter during the process, many will re-cycle through the stages before the lifestyle change becomes truly established.
Another major barrier to patient adherence is a lack of physician-patient communication. According to the study in Medscape, physicians interrupt patients an average of 18 seconds into the patient's description of a problem. The study also found that 54 percent of patients' problems and 45 percent of patients' concerns are neither prompted by the physician nor disclosed by the patient. When this communication breakdown occurs, it's possible to base a patient's treatment on general assumptions instead of tailoring the treatment plan to the individual.
To achieve good communication, it's important to have an understanding that there is no one-size-fits-all approach to fostering lifestyle changes and ensuring patient follow-up. A 2011 Americans in Motion-Healthy Interventions (AIM-HI) research study suggests that helping patients set small, incremental goals can better encourage buy-in to those changes. Instead of recommending that patients engage in 30–60 minutes of uninterrupted physical activity a day, the article suggests asking what they think they can do for 5–10 minutes to improve their activity. For example, a patient who is leading a sedentary lifestyle may benefit from walking up a flight of stairs instead of taking the elevator or going on long walks after work. If the patient has high confidence about achieving a goal, then it should be written on a fitness prescription — a form used to record measurable fitness goals — and asked about at future visits. If the patient has low confidence about the goal, the study recommends working to select one that is more realistic.
By communicating more clearly with patients to promote a better understanding of the issue at hand and by fostering a step-by-step lifestyle-modification process that fits individual patients' needs, you can help encourage your patients and start them off on the road to better health.