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Monica Nandwani, DNP, RN, FNP-BC: consultant/advisor/speaker: Phathom, Salix.
Constipation is a multisymptom condition that can include abdominal pain, bloating, distension, infrequent stools, hard stools, and straining, to name a few. Therefore, the patient’s narrative—or the history of their present illness—is critical to informing healthcare professional (HCP) decision-making and individualizing therapy.
Despite this—and the patient’s narrative being one of the most important tools in our toolbox—the literature has highlighted that, on average, HCPs interrupt their patient’s initial statement within the first 22 seconds. Therefore, we need to be mindful about allowing our patients to share their illness context, experiences, and symptoms, as well as the impact the illness is having on their lives. This will allow us to determine which diagnostic tests and treatment options would be most appropriate and provide the best path for the patient.
Of interest, the literature also shows that if we allow our patients to share their narrative uninterrupted, they usually do not speak for more than 2 minutes. Often, we want to get this critical information, and we might interject when our patients are sharing their narrative. It is important, however, to keep in mind that if we let them speak in an uninterrupted manner, we can gather important information.
Two useful paradigms that I have leveraged to help improve the patient–HCP relationship are the “I’m Late” mnemonic from the Rome Foundation and the SHARE approach from the Agency for Healthcare Research and Quality (AHRQ).
“I’m Late” Mnemonic
The “I’m Late” mnemonic was published in the Rome Foundation working team report reviewing evidence and recommendations on communication skills and the patient–HCP relationship.
“I’m Late” stands for:
The SHARE approach is the AHRQ’s 5‑step resource for enhancing shared decision-making. The AHRQ website includes a wealth of information, including examples of dialogue, tool kits, and a workshop curriculum.
SHARE stands for:
Why is it important to use the SHARE approach? We know that patient adherence to treatment is enhanced by shared decision-making. A positive patient‒HCP relationship establishes trust, builds confidence, and facilitates collaboration. It can influence both patient and HCP satisfaction by providing a sense of connection.
Using the Models Effectively
It can be difficult for patients to talk about their bowel habits. Understandably, this may be a very private matter, or perhaps they are unaware of how to accurately describe what they are experiencing. Making the patient comfortable by asking open‑ended questions about symptoms and discussing patterns that might be seen with chronic idiopathic constipation can help elicit details from the patient.
I also find that providing a comprehensive review of treatment options can help with shared decision-making. First, however, one needs to determine what the patient’s goals and preferences are, as well as how much information the patient wants. Some patients want to hear all the available options, but others may prefer to rely on the HCP’s direction and recommendations. It also is important to set realistic goals and empower the patient to take responsibility. I often frame this discussion as: “These are the 5 options, and these are the pros and cons of each. Are you ready to make a decision, or do you need time to think about which path you would like to take?”
Finally, we need to determine whether the treatment options we provide fit the patient’s needs, individual situation, and lifestyle. The options must be feasible for their circumstances. If not, it can be challenging to adhere to the recommendations, and they will therefore not be set up for success. This is where shared decision-making is critical.
In summary, tools are available to help HCPs optimize communication and the patient–HCP relationship, which can impact patient adherence to treatment and clinical outcomes.
What models for patient interaction do you use effectively? Join the conversation by sharing a comment.