Living with a long-term health condition demands patients engage in a range of self-management behaviors, including treatment adherence and lifestyle changes. Initiating and maintaining behavior change can be challenging, and patients often require support from their broader support networks to be successful over the long-term.
Support can come from many sources including friends, family, as well as HCPs. Pharma companies and pharmacies too, are increasingly providing individuals with access to telephone support as part of their broader patient communication. However, the degree to which patients are actively engaged by telephone-based support varies considerably.
Support Throughout Patient Journeys
Much of the telephone-based support offered by pharma helps patients to access treatment or manage insurance issues. While an important first step, it is remiss of pharma to ignore the ongoing adherence support needs of patients once they have initiated treatment. Indeed, it is often not until a patient starts on a medication that they may develop questions or identify concerns.
For many, adherence challenges arise a few weeks into treatment when patients may start to feel better, when they start to experience treatment side effects, or when (though the medication is clinically working) the individual doesn’t notice a change. It is at this point that telephone support, along with complimentary support delivered across other channels, can be effective in facilitating an understanding of the necessity for ongoing treatment while balancing any concerns individuals may have.
Telephone support scheduled at regular intervals can also address other challenges as they occur, and mitigate their impact on treatment adherence and optimal self-management. If executed and targeted appropriately, regular telephone support can act as a strong motivator for patients in helping them track and reinforce their progress in managing treatment for a long-term condition.
If telephone support is already in place to support access and reimbursement, a logical next step is to expand this support to address the ongoing needs of patients once on treatment.
Support Sustained Behavior Change
Even if patients are supported over the course of their treatment, the telephone support offered by pharma is often little more than providing information. It is now widely recognized that information alone does not effectively support patients to change their health-related behavior. To drive real behavior change among patient populations, support must be tailored to the needs of an individual patient. The tailoring of telephone support in this way requires a high degree of skill. Those individuals delivering telephone support need to be trained to understand both how to elicit and how to address patients’ needs to facilitate sustained behavior change.
Health Psychology and Behavior Change Techniques
Health psychology gives us a means of identifying patient’s needs by providing models and frameworks to understand the motivators and barriers to change for an individual patient. This discipline also provides a means of identifying and applying behavior change techniques (BCTs) appropriate to each patient given their need. Of course, it’s not enough just to learn the names and descriptions of these techniques, and individuals on the telephone must be able to flexibly apply the most appropriate change technique based on patient need.
For example, if a patient were to express concerns about side effects, the “pros and cons,” BCT could be used to help facilitate the patient to make a list of the advantages and disadvantages of treatment before guiding them to discuss this information with their physician. Similarly, if a patient expresses a lack of confidence in their ability to do what is required, the “action planning,” BCT could be used to help the patient identify what steps are needed to complete the behavior.
When conversations with patients are grounded in health psychology they become inherently patient-centric and action-orientated. They provide not only information but also help the patient to adopt new ways of thinking and new self-management skills.
Training in Communication Skills
Unlike face-to-face communication, telephone communication precludes the use of non-verbal cues such as eye contact and body language. This makes verbal communication skills especially important. However, training in even basic verbal communication skills is often overlooked as it is erroneously assumed that these skills are already mastered. The fact is, even if the person providing support is a good communicator, these skills need consistent attention. Individuals providing telephone support should be trained to regularly reflect on their application of these skills and evaluate their performance.
Communication skills include those that relate to pace and tone of voice, as well as those that relate more to the content of what is being said, such as techniques of normalizing, reflective listening, and summarizing. Using these skills effectively can help the patient feel heard, with their needs understood and acknowledged.
In addition to considering the content of training programs, it is important to consider their format. Training should not be viewed as a one-and-done activity, but rather seen a part of ongoing professional development in which individuals are supported to continually evaluate and refine their performance to enhance the support they can offer patients over the telephone.
In terms of modality, training can be delivered through many media. While our preference is for face-to-face training, the logistics for this are not always possible. It is key therefore that options are provided not only for face-to-face training but also for real-time online training, including tools that can be accessed at any time. A common approach is to provide face-to-face training initially and to offer follow-up training online.
Behavior change isn’t easy and telephone-based support can have an important role in supporting patients to change health-related behaviors over the long-term. Effective telephone-based support demands ongoing training in health psychology theory, BCT application, and patient-centered communication skills. Training should be viewed as an ongoing process that requires regular input to ensure that skills are being effectively used and refined over time.