Rapid Reference to Lifestyle and Behaviour Change

CHAPTER 1: It's a serious problem
* Brief epidemiology and the disease states caused or
exacerbated by patient inaction/non compliance leading to a
likelihood of diminishing quality of life and life expectancy
(with evidence); drug and other therapies available to help
behavior change.



CHAPTER 2: Why bother?

Behaviour change does happen (example of COPD & smoking where
the woman stopped years ago after advice). Also, the man who
attributes his efforts to quit drinking to when his general
practitioner raised the subject of his drinking in a non-
judgmental way and merely showed respectful concern. This man
quit drinking 10 years later.
Examples of behaviour change special patient groups and the
comorbidity they need to counter (e.g. hypertensive, obese
diabetic), the hypertensive antisocial drinker, the COPD
afflicted smoker, the promiscuous drug abuser etc: alcohol,
drugs, diet/obesity, smoking, limited exercise, stress,
promiscuity diabetes and hypertension and COPD.
Generic skills can be used in all kinds of consultations -
examples
It can make a difference - general comments on evidence for
effectiveness of intervention


* CHAPTER 3: Making advice work

* Some guidelines on making the best of brief advice-giving.

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CHAPTER 4: The skilful consultation

Analogy of breaking bad news and examples
Example of script (diabetes script analysis exercise): consider
shifts from skilful consultation to breakdown
Concordant and discordant consulting


CHAPTER 5: Raising the subject & assessing motivation

Includes assessment of importance and confidence at the heart of
this chapter, with some examples.
* Raising the subject: Why take such care in raising the
subject? Four ways to raise the subject; ways to structure the
session;
* Assessing motivation: Assessing importance & confidence;
Assessing desire or readiness to change; Tip for assessing
motivation to change;
Potholes: getting in and out of them: Raising the subject too
abruptly; The question-answer-trap; Investigating bad behaviour;
quantity is all that matters;
Chapter summary and references


CHAPTER 6: Exploring the importance of change

Why? (nobody attempts change unless they will avoid bad or gain
good )
* How? (menu of ways to explore importance)
Potholes to avoid (lecturing with biomedical information to
convince patient that it is more important than he/she thinks)
Troubleshooting
Dialogue examples


CHAPTER 7: Enhancing confidence to change

Why? (healthy people don't set themselves up to fail, so must
first feel capable.)
* How? (menu of ways to explore and enhance confidence, offer
information about successful cases, teach that multiple relapses
predicts success, return to scaling questions, e.g "what would
it take for you to...")
Potholes to avoid (seeming glib or condescending about the
difficulty of change, cheer-leading)
Troubleshooting (hopelessness, "I can't change because the
entire world has turned against me...")
Dialogue examples


CHAPTER 8: Relapse & recovering commitment to change

Why? (almost everybody relapses, relapse is part of change)
* How? (info about relapse being normal, get agreement to try
again with slightly different plan.)


CHAPTER 9: Singing from the same sheet: the value of teamwork

The importance of nurses and doctors taking the same approach to
behaviour change, and how to achieve this great idea!


CHAPTER 10: The world of theory & evidence

A brief summary of models of behaviour change and a brief
summary of evidence
* Menu of several session diagrams
* Quick literature review


CHAPTER 11

Agreement, patient totally hopeless, uncomfortable with being
non-directive, given the weight of these issues, patient blames
everything else, patient has psych symptoms you don't feel you
can handle?


APPENDICES:

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