Troubleshooting: Common Challenges In Aligning Decisions With Patients’ Health Priorities
Challenge: The patient’s health outcome goals are likely not achievable with interventions that patient is willing or able to adhere to
“I know you don’t want (intervention), but it may help with the (health outcome goal or other healthcare preference). You said those things are important.”
Mrs. B doesn’t use her CPAP
“I know you can’t watch your grandchildren because you’re tired during the day. I know you don’t want to use your CPAP machine. I’m concerned the sleep apnea is the reason why you’re tired. Would you be willing to try the new CPAP mask for one week to see if it helps with your fatigue and allows you to spend more time with your grandchildren?”
“Can you tell me what you find difficult or bothersome about the (intervention)?”
Tip: Inquire about past experiences, or social, economic cultural, or religious reasons that affect adherence:
“Why do you feel you can’t (intervention)? Maybe we can figure out how to make it easier, or less bothersome to make it more likely that you will achieve your goal to (health outcome goal).
Mrs. B has had two recent hospital admissions for CHF. Both of Mrs. B’s hospital admissions have been after a high salt meal. In general she has found it difficult to stay on a low salt diet.
“I know that staying out of the hospital has been a priority for you and you know that too much salt worsened your heart failure and led to your recent hospital stays. I wonder if we can explore more about your thoughts on your diet, so you hopefully stay out of the hospital and spend more time volunteering and helping with your grandchildren.’’
“It sounds frustrating”
“I know this is hard. I wish we’d be able to manage without (bothersome intervention), but it’s going to be hard to do that if we want to achieve your goal of (health outcome goal).”
“I understand that (bothersome symptom) is preventing you from (health outcome goal). It’s unlikely that (intervention patient feels is the cause) is the reason you are feeling (bothersome symptom). There are some other (interventions/ conditions) that may be causing (bothersome symptom). Is it okay if we discuss some of those possibilities?”
What seems burdensome to patients varies. Examples include having to take multiple medications, frequent blood tests, clinician visits, specific diets.
Decrease frequency of self-management tasks such as fingersticks or frequency of healthcare visits.
“I worry that we can’t achieve your goal to (health outcome goal). I wonder if there are other ways to fulfill your (underlying value) that could be more achievable”