Better communication, shared decision-making can improve outcomes

Key takeaways:

• Patients need to understand the risks and benefits of each treatment option.
• Patients should express their own goals, beliefs and concerns.
• Physicians should speak slowly and use simple language.

ANAHEIM, Calif. — Improvements in communication including shared decision-making can improve outcomes for patients with asthma, according to a presentation at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

“We’re not understanding their needs. We’re not understanding their preferences. And we need to be able to do that,” Michael S. Blaiss, MD, clinical professor of pediatrics at Medical College of Georgia at Augusta University, said during his presentation.

“We need to invite the patient to be an active partner in their care,” Blaiss, who also is a member of the Healio Allergy/Asthma Peer Perspective Board, continued.

Shared decision-making

Blaiss defined shared decision-making as the involvement of patients with their providers in making health care decisions that consider patient preferences and that are informed by the best available evidence about options and potential benefits and harms.

“They need to know the particular outcomes associated with each treatment,” Blaiss said, noting these legal imperatives. “They also need the cost associated with this treatment.”

Physicians also need to consider patient preferences, values and goals, Blaiss continued.

“There’s an ethical imperative here,” Blaiss said. “Patients really do want to be involved.”

However, Blaiss said, physicians may believe they are engaging in shared decision-making, but they really are not.

“We know from numerous studies that doctors many times think they’re doing it, but when you go to the patient population, they will tell you it’s not happening,” he said.

Blaiss also said that patients often are afraid of physicians and may share things with nurses or with the front office staff that they would not share with doctors.

“We have to invite them, in fact, to be part of this process,” he said.

In fact, Blaiss said, patients often know more than physicians give them credit for knowing, underscoring the importance of evidence-based care.

“Patients want to be knowledgeable, and we have to help them there and educate them there and give them credit for wanting to do the best thing for their condition,” he said.

Additionally, physicians can work with patients to determine the most appropriate allocation of resources.

“Patients should get the care they need and no less, and the care they want and no more,” Blaiss said.

Improving communication

Blaiss acknowledged the challenges in improving communication with patients.

“I’m getting really tired of when I go to the doctor and all I see is the back of his or her head, because all they’re doing is looking at their screen and typing away and asking you questions,” he said. “That is not patient-physician communication.”

Key strategies for facilitating good communication include a congenial demeanor; allowing patients to express their goals, beliefs and concerns; and empathy, reassurance and prompt handling of any concerns.

“We know that the average physician cuts off the patient at less than 1 minute in an office practice,” Blaiss said. “We don’t listen to the patient population. And we should be doing a better job.”

Also, strategies may include encouragement and praise, appropriate and personalized information, and feedback and review.

“We also need to have significant empathy, be able to reassure our patients,” Blaiss said.

Physicians can do a better job of communicating with patients who have low health literacy as well, he continued.

“We really have to do a much better job there at giving them information,” Blaiss said.

For example, Blaiss suggested that physicians should order information from most to least important. They also should speak slowly and use simple language, avoiding medical language if possible.

Numeric concepts should be simple too, using numbers instead of percentages. Plus, physicians should frame instructions effectively via illustrative anecdotes, drawings, pictures, tables or graphs.

“One of the most important things I mentioned here is the teach-back method, where in fact you teach the patient, and then the patient teaches you back so in fact you know that they heard exactly what you said,” Blaiss said.

Physicians also can ask a second person attending the visit such as a nurse or member of the patient’s family to repeat the main messages. Additionally, physicians should pay attention to any nonverbal cues the patient may be expressing.

Finally, Blaiss said, patients should be encouraged to feel comfortable about asking questions.

“We need to be better at communicating with our patient if we’re going to get better adherence and better care,” he said.

Education, next steps

Blaiss emphasized the lack of understanding in the patient population, especially among patients with asthma.

“So many of our patients don’t understand the chronicity of asthma, and why, in fact, they have to stay on treatment to control the problem,” he said.

For example, patients may not understand the differences between preventive and rescue inhalers, or they may find the use of multiple inhalers to be too time consuming, leading to poor adherence.

These educational efforts need to reach spouses and caregivers too, Blaiss continued, along with the general medical community beyond asthma and allergy specialists.

“I think there’s a general lack of knowledge to truly understand asthma and the need for better control of this patient population,” he said. “We need to be doing a better job with everyone in asthma education.”

Overall, Blaiss said, shared decision-making as part of improved communication, and education is essential to improved care.

“We get better outcomes, and that’s what we want for each and every asthma patient,” Blaiss said. “They all deserve that.”