Engaging Patients In Care Planning – What Providers Say And How They Say It Matters

The following is s post by Carolyn Thomas, a fellow 2012 Stanford Medicine X e-patient scholar, which she wrote for her award-winning blog  Heart Sisters.

Imagine that your daughter is preparing for a junior ski race. It’s five minutes before the start of the race. You want to give her some meaningful advice. Which one of these two messages are you going to use?

The following is s post by Carolyn Thomas, a fellow 2012 Stanford Medicine X e-patient scholar, which she wrote for her award-winning blog  Heart Sisters.

Imagine that your daughter is preparing for a junior ski race. It’s five minutes before the start of the race. You want to give her some meaningful advice. Which one of these two messages are you going to use?

1. “Honey, remember to do XYZ – it will help you avoid losing!”
2. “Honey, remember to do XYZ – it will make you faster and you will have more fun!”

Austrian physician Dr. Franz Wiesbauer, writing to his fellow doctors in a Medcrunch article called Why Your Health Message Does Not Work, has asked this question many times in an informal little experiment. His results?

“Everyone chose answer #2. Why? Because it’s more encouraging. It’s an approach message – and approach goals (like happiness or success) rock!

“Our problem as physicians is that we are constantly sending out avoidance messages to our patients, and these have been proven to be much less effective.”

The avoidance messages that doctors may give to their patients include:

• “Stop smoking so you won’t develop lung cancer or heart disease!”
• “Lose weight so you won’t get diabetes!”
• “Take your daily blood pressure meds so you won’t have a stroke!”

Most well-meaning doctors, Dr. Wiesbauer believes, do try to deliver this kind of sound health advice to their patients, but, based on results, it seems that we patients are just not listening:

“We tell them again, still to no avail. Frustration sets in and we ask ourselves why they come to us in the first place when they won’t do what we tell them to!”

“It’s not that these patients are stupid by any means. Many of them are really smart and successful. Many have university degrees, drive expensive cars, live in beautiful houses. So most of them know the art of setting goals and achieving them.

“So what’s the problem we are facing here? We think it’s because the whole health-communication paradigm is broken. Why? Because health itself is a misnomer.”

Researchers in the field of goal-setting theory tell us that the most effective goals are indeed ones that move you toward a particular objective, rather than away from something you’re trying to avoid.

Dr. Wiesbauer adds that if you ask patients what “health” is, many will come up with responses like “not being sick” or “not being in the hospital” –  as if health is merely the absence of disease.

He also explains to other doctors the difference between proposing an avoidance goal and an approach goal.  Psychologists have found that avoidance goals (“Do this so you won’t get sick”) are far less effective than approach goals (“Do this so you’ll feel great!)

For example, I could head to the gym today to help prevent another heart attack (which is an avoidance goal) or I could head to the gym today to stay strong and fit (an approach goal).

Or I could say NO to second helpings at the Empress Hotel’s famous Death by Chocolate buffet because I don’t want to gain weight (avoidance) or I could say NO because I really want to wake up tomorrow morning feeling good about myself (approach).

Psychology professors Dr. Andrew Elliot and Dr. Ken Sheldon have pioneered research* about these approach and avoidance goals. Their research suggests that framing a goal with an approach message is almost always more successful than framing it as an avoidance message.

They add that when we pursue avoidance goals (“I’m doing this to avoid something bad happening!”), we are far more likely to experience:

• less satisfaction with progress and more negative feelings about progress with personal goals
• decreased self-esteem, personal control and vitality
• less satisfaction with life
• less competence in relation to goal pursuits

And interestingly, avoidance goals are also more likely to be associated with procrastination.

As Dr. Wiesbauer says, the average patient’s definition of health as the absence of disease counteracts the medical profession’s preventive health measures.

Reframing a health goal from avoidance to approach is where the concept of wellbeing enters the stage. So Dr. Wiesbauer warns his fellow physicians:

“We have to communicate to our patients the concept of wellbeing or wellness (we think that the word ‘fitness’ has too much of a sporty touch).

“Our personal wellbeing is a continuum between death, disease, health, wellbeing and perfect wellbeing. It is not a dichotomy.  Doctors and their patients have to realize that we are not either healthy or diseased. We all have our sets of risk factors and protective factors. We are all on a continuum and we have to strive for optimal wellbeing.”

* Elliot, A. J. & Sheldon, K. M. (1997).  Avoidance achievement motivation: A personal goals analysis. Journal of Personality and Social Psychology, 73, 171-185.

Tagged: Care Planning, collaborative decision making, doctor-patient communication, doctor-patient relationship, empowered patients, evidence-based research, Heart Care, patient compliance, patient engagement, patient satisfaction, Patient-centered Communications, physician-patient communication. doctor-patient communication, physician-patient communications, Self Efficacy