Slide 1: Educational use disclaimer
This presentation is offered for educational purposes only, intended to serve as continuing medical education for health care professionals. The content of the presentation represents the views and opinions of the original creators of such content and does not necessarily represent the views or opin
Slide 2: A:CARE Congress: Individual adherence strategies in women's health
A:CARE CONGRESS Individual adherence strategies and their impact on patient experience in women’s health Prof. Johannes Bitzer Prof. Rossella Nappi Prof. Rob Horne Director of the Diploma of Advanced Studies in Sexual Full Professor of Obstetrics and Gynecology, Professor of Behavioral Medicine at t
Slide 3: The impact of non-adherence in women's health unintended pregnancies
INDIVIDUAL ADHERENCE STRATEGIES AND THEIR IMPACT ON PATIENT EXPERIENCE IN WOMEN’S HEALTH The impact of non-adherence in women´s health unintended pregnancies Prof. Johannes Bitzer Advanced Study Center of the University of Basel Department of Obstetrics and Gynecology at the University Hospitals of
Slide 4: The pandemic of unintended pregnancies
The pandemic of unintended pregnancies These reproductive health Of these unintended Unintended outcomes occur irrespective of pregnancies, 61% ended in pregnancies have a country income level, region or abortion. This translates to 73 higher risk of the legal status of abortion. million abortions p
Slide 5: Why Does It Happen?
Why Does It Happen? No contraception • Lack of motivation • Fear of health risks and side effects Discontinuation of contraception Current • Side effects beliefs • Bad image Forgetting or non-adherence to proper use of the method GLO2208860 | Nov-21 | 5
Slide 6: How to improve adherence in Contraception
How to improve adherence in Contraception Patient centered, shared decision-making based counselling and care • Increase and maintain motivation by providing knowledge (empowerment) to the user The medical strategy • Help the user to come to a self-determined, individual benefit/risk evaluation (thi
Slide 7: The right method
The right method NONHORMONAL COMBINED ORAL CONTRACEPTIVES HORMONAL CONTRACEPTIVES CONTRACEPTIVES Progestogen type Non-daily (non-oral) Clinician Norethisterone Contraceptives dependent Levonorgestrel Gestodene EE dose Chlormadinonacetate Desogestrel 15 µg Drospirenone 20 µg Cyproterone acetate Dieno
Slide 8: What do doctors want, what do women want?
What do doctors want, what do women want? THE HEALTH CARE PROFESSIONAL THE PATIENT, CLIENT, USER Maximal efficacy Maximize efficacy Independent of Easy to use partner Realize Under the control Linked/ not linked to Medical Optimize additional of the woman sexual activity Counselling tolerability hea
Slide 9: Make the best fit between the woman, the context and the method
Make the best fit between Method the woman, Profile the context and the method Professional Competence Communication Competence Context Woman Bitzer J, Oppelt PG, Deten A. Evaluation of a patient-centred, needs-based approach to Profile support shared decision making in contraceptive counselling: th
Slide 10: The Science and Art of Contraceptive Counselling
The Science and Art of Contraceptive Counselling Patient centered communication Information and Education Shared decision making Bitzer J, Marin V, Lira J. Contraceptive counselling and care: a personalized interactive approach. Eur J Contracept Reprod Health Care. 2017 Dec;22(6):418-423. GLO2208860
Slide 11: The Contraceptive Dialogue
The Contraceptive Dialogue Listen to patient‘s Keep in mind (exlude) Step 1 wishes,expectations and methods she does not Exclusion based on the priorities want (personal fit) patients, preferences Assess biopsychosocial Step 2 profile and context Exclude methods Exclusion based on which are not eleg
Slide 12: Give evidence based information in a patient centered way
Give evidence based information in a patient centered way • Inform and educate about THE EPE PRINCIPLE methods in understandable way based on EBM Elicit • Needs, knowledge, expectations, experience • Small units of information, Provide Structurizing, • Summarizing • Efficacy • Health Risks Elicit •
Slide 13: Recommendations and guidelines for risk counselling
Recommendations and guidelines for risk counselling Specify verbal risk descriptions if possible, with Show positive numbers. Compare to and negative Low high etc. everyday risk outcomes Visualize Understand Describe everyday statistics Absolute Risk in risk and relation to a well- absolute risk def
Slide 14: Contraceptive counselling and care is a continuous benefit/risk evaluation
Contraceptive The woman´s role counselling The woman gives weight to these EBM based information and care is a Risks/Side effects continuous Benefits Effective protection against Cardiovascular etc Complications (Insertion, benefit/risk unwanted pregnancy Additional benefits Removal Somatic/psycholo
Slide 15: Navigating menopause with your patients
INDIVIDUAL ADHERENCE STRATEGIES AND THEIR IMPACT ON PATIENT EXPERIENCE IN WOMEN’S HEALTH Navigating menopause with your patients Prof. Rossella Nappi MD, PhD Research Center for Reproductive Medicine and Unit of Gynecological Endocrinology & Menopause – Dept Ob/Gyn, IRCCS “S. Matteo Foundation”, Uni
Slide 16: Menopause is a long journey
Menopause is a long journey INDIVIDUAL EXPERIENCE FSH The Road to Menopause FMP Increase of the commonly observed menopausal symptoms: hot flashes, poor sleep, adverse mood, and vaginal dryness Pre-MT Early MT Late MT Increase of risk factors and medical conditions associated with menopause and agin
Slide 17: The nature-nurture issue of Menopause beliefs
The nature-nurture issue of Menopause beliefs Menopause is a natural 7 and inevitable part of Europe (n = 2,035) the aging process US (n = 675) Level of agreement, mean scores Japan (n = 750) 6 Menopause is an undesired Thanks to menopause I do time in a women’s life, since not worry about my it imp
Slide 18: The burden of menopause is significant
The burden of menopause is significant The average woman is postmenopausal for more than 1/3 of her life ~50%–75% of women in midlife experience VMS The median duration of VMS ~30%–50% experience GSM in midlife and beyond over the menopause transition is 7.4 years VMS = Vasomotor Symptoms GSM= Genit
Slide 19: Menopause is a bio-psycho-socio-cultural process
Menopause is a bio-psycho-socio-cultural process THE “HOT-FLUSHES” EXAMPLE Stress and life style triggers Experience of Mood and Bodily and hot flushes and emotional physical changes night sweats reaction Thoughts and Behavioural beliefs strategies Developmental, social & cultural Neuroendocrine mec
Slide 20: There is not only one menopause!
There is not only one menopause! Duration of treatments Age Attitudes to chronic Type of menopause medical (natural, surgical, chemo- interventions /radio-therapy) Phenotyping is the key Level of general Time since health literacy menopause onset Presence of underlying Type, intensity and duration c
Slide 21: Specific challenges at menopause
Specific challenges at menopause Menopause should be treated Benefit-risk evaluation like any other medical may be difficult condition, especially if • Lack of awareness distressing symptoms and/or specific risk factors are • Sensitive topics present • Goals and Concerns • Collect history • Complex
Slide 22: Successful communication at menopause
Successful communication at menopause OARS Open questions that encourage Affirmations that foster Reflections that indicate the Summaries that extend the further elaboration and positive feelings during the clinician has heard and basic reflections to include consideration consultation accurately un
Slide 23: Individualizing discussions with women about treatment of menopausal symptoms
Individualizing discussions with women about treatment of menopausal symptoms HCP review of the Assess nature and Partner with patient literature to develop severity of to develop an up-to-date menopausal individualized understanding of symptoms, age, treatment plan that nuances regarding years sinc
Slide 24: Shared decision making at menopause is complex
Shared decision making at menopause is complex Menopause as a Natural Event Communication Skills Multitude of Phenotypes Risk-Benefit Balance Individualized Management Parish SJ, Nappi RE, Kingsberg S. Perspectives on counseling patients about menopausal hormone therapy: strategies in a complex data
Slide 25: Aiming at precision therapy in menopausal women
Aiming at precision therapy in menopausal women Consider Guidelines on Menopausal Therapy and on other Conditions in the context of Menopausal Medicine to manage symptoms and prevent chronic conditions Promote Primary Prevention and a healthy Diet and Life-Style Control Blood Pressure and other CVD
Slide 26: Successful communication and shared decision-making lead to better health outcomes
Successful communication and shared decision-making lead to better health outcomes TAKE THE TIME TO CLEARLY PRESENT EVIDENCE IN ORDER TO ENGAGE YOUR PATIENTS IN THEIR OWN MEDICAL DECISION Improve Allow choices Put risks and Enhance Increase knowledge of better aligned benefits into adherence to pati
Slide 27: Individual adherence strategies and their impact on patient experience in women's health
INDIVIDUAL ADHERENCE STRATEGIES AND THEIR IMPACT ON PATIENT EXPERIENCE IN WOMEN’S HEALTH Individual adherence strategies and their impact on patient experience in women’s health Prof. Rob Horne University College London, UK GLO2208860 | Nov-21 | 27
Slide 28: The Perceptions & Practicalities Approach (PaPA)
The Perceptions & Practicalities Approach (PaPA)1-3 A FRAMEWORK FOR DEVELOPING ADHERENCE SUPPORT– APPLIED IN NICE MEDICINES ADHERENCE GUIDELINES Intentional Unintentional process process Perceptions Practicalities e.g. beliefs, MOTIVATION ABILITY e.g. capability & emotions & resource background limi
Slide 29: Disconnects drive the behavioral gap
Disconnects drive the behavioral gap THE FUNDAMENTAL CAUSE OF NON-ADHERENCE IS OFTEN A DISCONNECT BETWEEN BELIEFS AND EXPECTATIONS OF PRESCRIBER AND PATIENT1,2 Match? Disconnects? Knowledge, Knowledge, beliefs beliefs and and expectations expectations about illness and about illness and treatment tr
Slide 30: The Necessity-Concerns Framework (NCF)
Understanding treatment beliefs: The Necessity- Concerns Framework (NCF)1,2 DISEASE-AGNOSTIC FRAMEWORK > 27,000 patients Necessity Concerns for action about action >18 countries > 23 different & healthcare therapy areas systems 1. Foot H, La Caze A, Gujral G, Cottrell N. The necessity-concerns frame
Slide 31: Perceptions & practicalities driving non-adherence to osteoporosis treatment
Perceptions & practicalities driving non-adherence to osteoporosis treatment DOUBTS ABOUT TREATMENT HIGH CONCERNS ABOUT PRACTICAL DIFFICULTIES NECESSITY/ EFFICACY MEDICINES • I’m not at risk • Perceptions of high risk of • Understanding and side-effects health literacy • Osteoporosis is normal part
Slide 32: NCF in women with breast cancer prescribed endocrine therapy
The Necessity-Concerns Framework (NCF) in women with breast cancer prescribed endocrine therapy QUALITATIVE RESEARCH WITH 30 WOMEN PRESCRIBED ENDOCRINE THERAPY1 “Well since the option is keep taking it or be dead, it’s not much of a choice for me.” “I absolutely hate taking Vanessa, 63, adherent thi
Slide 33: NCF in women with breast cancer prescribed endocrine therapy
The Necessity-Concerns Framework (NCF) in women with breast cancer prescribed endocrine therapy MOST CONSISTENT PREDICTORS OF ADHERENCE WERE Having more positive medication beliefs (necessity-concerns differential) Higher perceived behavioral control over medication taking Being from a white ethnic
Slide 34: There may be disconnects between patient and HCP concerns
There may be disconnects between patient and HCP concerns Mismatch between patient and clinician ratings of ‘problems’? Patients rank ‘tolerability’ side effects as severe e.g. effect on family or partner, loss of hair, fatigue and nausea and vomiting1,2 Experience of subjective side effects reduces
Slide 35: Common-sense fit and common-sense defaults
Common-sense fit and common-sense defaults Patients need to see a common-sense fit between their understanding of the problem (the illness) and Illness Treatment the proposed solution (the treatment)1-3 For many patients that fit is not clear Just telling patients how the medicine works or how ? to
Slide 36: Illness prototypes and stereotypes and negative impact on sense of self
Illness prototypes and stereotypes and negative impact on sense of self1-3 DISEASE PROTOTYPES DISEASE STEREOTYPES People have pre-existing models of common What sort of person gets this disease? illnesses How much do I resemble them? Influence how and when we act if experien- cing symptoms or receiv
Slide 37: Solutions
Solutions GLO2208860 | Nov-21 | 37
Slide 38: 3-step Perceptions And Practicalities Approach (PAPA)
3-step Perceptions And Practicalities Approach (PAPA)1 A ‘NO-BLAME’ APPROACH TO FACILITATE AN HONEST AND OPEN DISCUSSION TO ADDRESS Perceptions Communicate a ‘common-sense rationale’ for why the treatment is needed – Taking account of the patients perceptions of the illness and symptom expectations.
Slide 39: PaPA based intervention in breast cancer survivors
PaPA based intervention in breast cancer survivors1 Self-directed psycho- Reduction in impact educational booklet of side effects (based on PaPA) (d=0.54, p=001) Reductions in Improvement in unintentional confidence managing non-adherence Feasibility and side effects acceptability study (d=0.31 p=.0
Slide 40: Supporting informed choice
Supporting informed choice Tools to communicate uncertainties and probabilities in an accessible form1 Necessity Concerns Support to help patients translate for action about action information about the relative risk and benefits into common- sense necessity beliefs and avoiding misplaced concerns2
Slide 41: Examples
Examples GLO2208860 | Nov-21 | 41
Slide 42: Communicating uncertainty, benefits, and risks
Communicating uncertainty, benefits, and risks EXAMPLE 1 DRUG BENEFITS IN OSTEOPOROSIS YOUR CHANCE OF BREAKING A WITHOUT WITH OSTEOPOROSIS MEDICINE BONE OVER THE NEXT 10 YEARS OSTEOPOROSIS MEDICINE Communication of PERSONAL Necessity e.g., 1• Bone is strengthened 2• Reduces risk of fracture (not ine
Slide 43: Communicating uncertainty, benefits, and risks
Communicating uncertainty, benefits, and risks EXAMPLE 2 PLACING RISK IN CONTEXT WITH BENEFIT1 The gut tissue becomes less inflamed Regular symptoms, such as diarrhoea and abdominal pain, become less common and occur only now and then Pros of taking It can protect against colon cancer mesalazi
Slide 44: Communicating uncertainty, benefits, and risks
Communicating uncertainty, benefits, and risks EXAMPLE 3 POSITIVE FRAMING OF SIDE-EFFECTS RISK This is what looks like, if This is what looks like, a side-effect is labelled if a side-effect is labelled as occurring in 1 in as occurring in 1 in 10 people 100 people A very common side- A common side-
Slide 45: Conclusions
Conclusions APPLY GOOD COMMUNICATION/CONSULTATION SKILLS COMBINED WITH PAPA TO ADDRESS NECESSITY BELIEFS AND CONCERNS TO IDENTIFY AND ADDRESS ADHERENCE DISCONNECTS Patient is not a ‘blank sheet’ that we can write the prescription instructions on Patients come with pre-existing ideas about their cond