Effective communication skills are a cornerstone of primary care. When caring for patients with chronic diseases, it is particularly important to ensure that they have a good understanding of their potential complications.
This empowers patients to become actively engaged in their own care. On the flipside, failure to arm patients with the right information at the appropriate time can negatively impact both care and safety.
How can effective communication dispense patients' misconceptions and boost patient activation levels? And what resources can doctors tap into to effectively communicate with patients who suffer from chronic diseases?
Patient awareness is lacking
In 2014, a review of 21 studies from 12 countries - including Australia, Canada, the United States, and the United Kingdom - published in the BMJ revealed that patients with cardiovascular disease, diabetes, or both lack knowledge of the complications related to their conditions, or otherwise have misconceptions about them.
Previously, a U.K. survey by Ipsos MORI found that under 50 percent of respondents with type 2 diabetes knew that their condition can lead to heart disease and premature mortality.
Likewise, only 40 percent of respondents appreciated the link between diabetes and stroke, and just over 60 percent of them knew that diabetes increases the risk of kidney disease and amputations.
"That is why it is vitally important that [primary care physicians] talk about good self-management of the condition and the link between this and its complications," explained Alison Currie, chair of Diabetes U.K., Coventry Group.
This enables patients to make educated choices, helping them to "live a healthy life, postpone the onset of the complications for as long as possible [...] [and] avoid unplanned admissions into hospital."
According to Dr. Anthony Bewley - a consultant dermatologist at Whipps Cross University Hospital and St Bart's NHS Trust, both in London, U.K. - another important aspect is that "good communication surrounding disease complications improves patient adherence to treatment, which is an important predictor of good clinical outcomes."
In the study, knowledge of the link between severe psoriasis and other diseases, such as psoriatic arthritis, cardiovascular disorders, and type 2 diabetes, was a main factor in encouraging patients to take their psoriasis medications.
Improving communication skills
It is worth noting that in the review published in the Journal of the European Academy of Dermatology and Venereology, patients reported "not obtaining enough information from physicians" as one of the main reasons for their lack of knowledge of disease complications.
Other research, published by the Patients Association, indicates that nearly 40 percent of U.K. patients rate their general practitioner's communication skills as below average.
Twenty-six percent of the helpline calls received by the association during the first 6 months of 2012 were related to communication issues with family doctors. Could offering primary care physicians more training in communication skills be beneficial? Evidence suggests so.
"It is very important to listen to the patients, find out what their expectations are, and work with them to meet those expectations," explained Dr. Bewley.
Timing is also crucial, said Currie. "Disease complications should be discussed when the patient is ready to understand and absorb the information," which is usually after they have had "time to digest and come to terms with the diagnosis."
Interestingly, the quality of the communication itself can have a direct impact on risk of complications. For example, a study published in Academic Medicine found that people with type 1 or type 2 diabetes were less likely to develop serious comorbidities and complications such as ketoacidosis or coma if their doctors demonstrated high levels of empathy during interactions.
The patient perspective
Bettina Wallace, a volunteer for the British Heart Foundation, was recently diagnosed with high blood pressure. For her, empathy on the physician's part is key in ensuring a positive patient experience.
She said, "It's about being understanding and using a language that doesn't cause the patient to leave the [clinic] feeling more anxious than when they went in."
Anuja Rawal has epilepsy. He added, "[Primary care physicians] are particularly important in this regard, because they know you better than any other healthcare professional, and can see the bigger picture, in terms of what your risks are. And if you know what to expect, you can do something about it."
Increasing patient activation
It is estimated that patients with low activation - those who, among other things, tend not to ask questions during consultations - account for up to 40 percent of the population, explained Dr. Matt Jameson Evans. He is the chief medical officer of HealthUnlocked, a social network for patients that aims to support self-management.
"These patients are less likely to play an active role in managing their health and, as a result, of experiencing good outcomes."
However, there are ways for doctors to increase their patients' activation. For example, the U.K. National Health Service (NHS) recommend "skills training in areas such as motivational interviewing techniques and communication skills."
This advice is based on the results of a survey of healthcare professionals, including primary care physicians, to identify challenges and facilitators to patient activation.
Beyond the consultation room
Time constraints can definitely be barriers to communication. How can an in-depth discussion about chronic conditions take place during a short routine consultation visit?
As a consequence, some general practices in the U.K. offer double or triple appointments to their patients in order to provide safe care. But this can put additional strain on doctors.
Against this backdrop, "helping people with long-term conditions find out more about their risks, after they leave the consultation room, becomes an important way to address communication challenges related to time constraints and support patient self-management," said Dr. Jameson Evans.
"There must be some kind of liaison between doctors and patients that enables the latter to find safe and accurate health information from reliable sources, so they can gain a realistic picture about their condition and the potential for serious complications."
Dr. Anthony Bewley
Resources that primary care physicians can highlight to patients include:
- social networks that offer peer-to-peer or expert support
- advocacy group websites for patients
- advocacy group websites for family members and carers
Of course, effective doctor-patient communication alone is unlikely to reduce the incidence of complications in people with chronic conditions.
Undoubtedly, however, sharing information about disease complications between patients and primary care physicians is an all-important step toward achieving positive change.