Diabetes Consultations for Personalised Care Planning – how to make them effective
Once diagnosed, Type 1 or Type 2 diabetes is a lifelong condition that requires people with it to have regular consultations with health professionals for medical check ups and discussions about the management of their condition. Increasingly, these consultations are being seen as opportunities to assess and improve confidence in self-management of the person living with diabetes, rather than the traditional approach of the health professional to give instructions. This is due to the recognition that active involvement of people with diabetes (and other long-term conditions) in decision-making about their health leads to greater satisfaction and better outcomes.
Personalised Care Planning is a UK health policy that accepts and promotes the partnership approach to decisions about diabetes management, recognising that the day to day decisions that people make are more likely to be adhered to than decisions made by a health professional in the small amount of time they are in contact with them. This article looks at the skills needed by both health professionals and people with diabetes in order to make the partnership approach to consultations a reality.
Skills for health professionals
The main skills required are asking open questions and then listening carefully and attentively to the answers. Ideally, the first question should be ‘what is your biggest concern about living with your diabetes at the moment?’ This open question ensures that the person with diabetes has the chance to voice their thoughts first and can set their priorities for discussion, rather than waiting to have their say when time may be short after the health professional has addressed their own agenda. Listening actively to the answer includes putting aside papers and computer screens and facing the person in a comfortable yet attentive posture, eg leaning forward slightly with arms unfolded. Knowing that they have the full attention of the health professional will make the person much more able to speak freely.
Once the person’s main concerns have been elicited in this way, the health professional may describe their own concerns about the person’s diabetes, enabling agreement between both parties about the content of the consultation. This process can be made quicker and easier if the person with diabetes has had access to any routine tests or investigation results prior to the consultation and has had time to reflect upon them. This key aspect of personalised care planning enables greater equality between the health professional and the person with diabetes and makes consultations very focussed on the person with diabetes’ priorities.
Helping people with diabetes set goals and plan what action they will take are also key skills for the health professional. With these key elements, a consultation will be more likely to result in a shared understanding of what will happen as a result. Goals need to be set by the person with diabetes, because their behaviour in relation to diabetes will depend on their goals. People are less likely to act if they perceive they are fulfilling the goals of others, including those of their health professionals. The skill of goal setting is to ask the person what they would like to achieve and by when – terminology might include ‘ambitions’, ‘achievements’ or ‘aims’ instead of ‘goals’. Helping people to clarify what they want and documenting it for reference are central to goal setting. Action planning is about creating actions for both health professional and person with diabetes and involves specifying exactly what each will do in the shorter term, towards achieving the person’s goal. Checking that actions decided upon are SMART – that is, Specific, Measureable, Actions, Realistic, Timescales – is also a key skill which ensures that what is decided upon really will take place.
Skills for people with diabetes
Traditionally, the role of the ‘patient’ was to listen passively and to try and carry out the instructions of the health professional. In personalised care planning, the ‘patient’ becomes a partner, indeed the dominant partner, since the actions and decisions of the person with diabetes will determine the outcomes of diabetes care much more than those of the health professional. The skills needed to work in collaboration include being able to reflect in advance on the test and investigation results received, to make a record of these and to voice their thoughts and wishes about them clearly in the discussion. Assertiveness may also be needed, to ensure they have an equal say in the consultation. A further skill is to ask clear questions and to repeat them, perhaps in a different way if they do not receive an understandable answer.
Skills for both health professional and person with diabetes
For both collaborators in a care planning consultation, using language that appreciates the other’s expertise, keeping calm and minimising distractions can make a huge difference to the process of the meeting and positively influence the outcomes. Genuine understanding of each other’s point of view creates a feeling of being on a shared journey on the person’s road of life with diabetes.
Source by Rosie Walker