Slide 1: Behavioral Science and Menopause
Behavioral Science and Menopause Prof. John Weinman King’s College London acarepro.abbott.com GLO2159217. August 2020
Slide 2: Presentation outline
Presentation outline Impact of menopause on behavior & adherence Behavioral frameworks to analyze adherence How can healthcare professionals deal with medication adherence in menopause setup 2 Proprietary and confidential — do not distribute acarepro.abbott.com GLO2159217. August 2020
Slide 3: Presentation outline
Presentation outline Impact of menopause on behavior & adherence Behavioral frameworks to analyze adherence How can healthcare professionals deal with medication adherence in menopause setup 3 Proprietary and confidential — do not distribute acarepro.abbott.com GLO2159217. August 2020
Slide 4: Adherence definition
Adherence definition Adherence – or the way patients follow and keep up with medical treatments, is an important aspect to improve the health of the overall population. FULFILMENT PERSISTENCE COMPLIANCE of a treatment means that of a treatment means that with treatment means 3 axes of the patient ha
Slide 5: Menopause – a crucial moment in women's lives
Menopause – a crucial moment in women’s lives Menopause occurs on average at 504 y.o., – one of the most crucial age in the lives of many women, as at this age 1 Careers are usually at peak5 2 Children are starting their own adult life6 3 Parents are often aged and sick and may require attention/car
Slide 6: Menopausal symptoms and associated taboo
Menopausal symptoms and associated taboo9 Up to 90% of the women experience symptoms at some point during menopause transition, with approximately half of them considering their symptoms bothersome*25-27 Roughly half of women do not seek medical advice*10 The topic remains a taboo9 in many societies
Slide 7: Impact of untreated menopause
Impact of untreated menopause Cognitive and psychological problems In addition to hot flushes, menopausal women may suffer from depression, anxiety, sleep deprivation and cognitive impairment.11, 12, 13 Impact on the professional environment Hot flushes lead to higher intention of post-menopause wom
Slide 8: Adherence and menopause
Adherence and menopause Approx. 31%, 45.6%*15 The proportion of women Menopause impacts adherence discontinuing the originally prescribed rates to treatments to other hormone regimen at 1 year 15 diseases**16,17,18 * Based on an indirect calculation where proportion of adherance to continuous combin
Slide 9: Presentation outline
Presentation outline Impact of menopause on behavior & adherence Behavioral frameworks to analyze adherence How can healthcare professionals deal with medication adherence in menopause setup 9 Proprietary and confidential — do not distribute acarepro.abbott.com GLO2159217. August 2020
Slide 10: What are the reasons for non-adherence?
What are the reasons for non-adherence? Early explanations for non-adherence focused on lack of understanding or forgetting These still form the basis of many interventions But interventions which provide information or reminders are not effective for those who are non-adherent19 (e.g. Choudhry et a
Slide 11: Current state of knowledge regarding determinants of health-related behavior: The COM-B framework
Current state of knowledge regarding determinants of health- related behavior: The COM-B framework • How to classify the modifiable factors: the COM-B Capability framework20 • Incorporates all the factors which have been found to influence health-related behaviors, and puts then into 3 broad groups
Slide 12: A new approach to classifying causes of non-adherence: COM-B
A new approach to classifying causes of non-adherence: COM-B21 CAPABILITY MOTIVATION OPPORTUNITY Physical Reflective Social e.g. dexterity, swallowing e.g. beliefs about illness, e.g. HCP communication, treatment social support Psychological e.g. memory, knowledge, Automatic Physical planning e.g. e
Slide 13: Applying COM-B framework to medication adherence in menopause
Applying COM-B framework to medication adherence in menopause CAPABILITY MOTIVATION OPPORTUNITY • Poor knowledge of • Beliefs about menopause/ • Complexity of regimen in menopause/available available treatments patients with comorbid treatments • Concerns about conditions • Poor understanding of ris
Slide 14: Implications for changing adherence behavior
Implications for changing adherence behavior Importance of Need to find out Address understanding INDIVIDUAL DRIVERS/ these with drivers/barriers for EACH BARRIERS for each APPROPRIATE PATIENT over time patient (C, O or M?) INTERVENTION22 22. Samuel S. Allemann, Robby Nieuwlaat, Bart J.F. van den Be
Slide 15: Presentation outline
Presentation outline Impact of menopause on behavior & adherence Behavioral frameworks to analyze adherence How can healthcare professionals deal with medication adherence in menopause setup 15 Proprietary and confidential — do not distribute acarepro.abbott.com GLO2159217. August 2020
Slide 16: Information is necessary but not enough to produce or change a behavior
Information is necessary but not enough to produce or change a behavior like adherence for most people Proprietary and confidential — do not distribute acarepro.abbott.com GLO2159217. August 2020
Slide 17: Using the consultation to facilitate informed adherence
Using the consultation to facilitate informed adherence Check patient’s understanding of treatment and, if necessary Provide clear rationale for necessity of treatment Elicit and address concerns Agree practical plan for how, where and when to take treatment Identify any possible barriers 17 Proprie
Slide 18: Most used communication strategies to influence the behavior of others
Most used communication strategies to influence the behavior of others Ordering, directing, demanding Warning or threatening May work in some Persuading with reason, logic, argument, or lecture settings, but is often least effective to Moralizing, preaching, telling what you “should” do change behav
Slide 19: Most effective communication strategies to influence the behavior of others
Most effective communication strategies to influence the behavior of others Collaboration Curiosity Nonjudgmental Least used strategies! Empathy Other-focused 19 Proprietary and confidential — do not distribute acarepro.abbott.com GLO2159217. August 2020
Slide 20: A different approach is needed: Motivational Interviewing
A different approach is needed……. Motivational Interviewing A client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence23 Miller & Rollnick (1995) 23.Rollnick, S., & Miller, W. R. (1995). What is motivational interviewing? behavioral and co
Slide 21: Motivational Interviewing
Motivational Interviewing Builds rapport and creates positive relationships with patients Scientifically supported clinical method for helping people change behavior; it is patient-focused and goal-directed Can assess and support adherence behavior May be different from the way you currently communi
Slide 22: Spirit of Motivational Interviewing
Spirit of Motivational Interviewing Collaboration Expertise Autonomy The key to Patient is the It is the communication expert on their patient who is and patient- own life in charge centered care 22 Proprietary and confidential — do not distribute acarepro.abbott.com GLO2159217. August 2020
Slide 23: Switch-off the "righting reflex"
Switch-off the “righting reflex” Natural to wish to solve problems Facilitate the patient to find their own solutions Enable the patient to hear their own reasons for adherence 23 Proprietary and confidential — do not distribute acarepro.abbott.com GLO2159217. August 2020
Slide 24: Basic Principles of Motivational Interviewing
4 Basic Principles of Motivational Interviewing Express Develop and Deal with Support empathy explore discord self-efficacy discrepancy (confidence) 24 Proprietary and confidential — do not distribute acarepro.abbott.com GLO2159217. August 2020
Slide 25: Basic Skills in MI: Oars
Basic Skills in MI: Oars Open questions Affirmation Reflection Summary 25 Proprietary and confidential — do not distribute acarepro.abbott.com GLO2159217. August 2020
Slide 26: O is for Open Questions
O is for Open Questions (Closed) • Are you taking your MHT medicine correctly? • Did that make you feel bad? • Do you want to change your eating habits? • Do you do enough exercise? • Is your diet unhealthy? Open questions • How are you getting on with your MHT? • Take me through your medicine-takin
Slide 27: A is for Affirmation
A is for Affirmation Affirmations build a patient’s belief that a change in behavior is possible, recognizing the patient’s strengths Any change, that is in a positive direction, are presented as evidence that this behavior change is important to the patient. You might say… “You showed a lot of comm
Slide 28: Validate their reasons for non-adherence
Validate their reasons for non-adherence I completely understand Sometimes life gets in the way You clearly care about what you put into your body; it really shows you care about your health Would you like us to think about a possible solution together? 28 28 Proprietary and confidential — do not di
Slide 29: R is for Reflective listening
R is for Reflective listening Paraphrasing what the patient has said Reflecting back the feelings underlying what they have said Reflecting with statements rather than questions Encouraging the patient to elaborate further Enabling you to check your understanding Indicating that you are listening “S
Slide 30: S is for Summarizing
S is for Summarizing Confirms your understanding Demonstrates listening Structures the patient’s thoughts and concerns Structures the consultation to move onto action planning “You are obviously concerned about your menopausal symptoms and the effects they are having on your life but you are relucta
Slide 31: Can I still give information?
Can I still give information? Permission “Would you like information on…” Ask “What do you already know about/understand by…” Provide Informing not advising Ask What do they think? How will they use the information? Do they have any questions? 31 Proprietary and confidential — do not distribute acar
Slide 32: Basic Elements of Motivational Interviewing
Basic Elements of Motivational Interviewing Asks open-ended questions vs. telling patients what to do Focuses on the patient’s preferences, values, and personal situations, not the HCP’s agenda Views the patient as expert Helps HCPs get insight into how to help patients better adhere Helps the patie
Slide 33: We don't have enough time …
We don’t have enough time … Learning Motivational Interviewing takes a lot of time, practice, and coaching We have time to learn a few questions that embody the Motivational Interviewing approach “Motivating questions” could make a difference for you and your patients 33 Proprietary and confidential
Slide 34: Dealing with emotional problems
Dealing with emotional problems Cognitive Behavior Therapy (CBT) acarepro.abbott.com GLO2159217. August 2020
Slide 35: Cognitive Behavior Therapy for Menopause
Cognitive Behavior Therapy for Menopause24 Physical Symptoms Thoughts Tension, butterflies, I’m not good enough, I’ll heart racing never get this finished Behavior Feelings Avoid situations, Anxious, stressed, overeating, doing upset, worried too much 24. Myra Hunter, Dr Melanie Smith in collaborati
Slide 36: Summary
Summary Menopause can be disruptive for many women Although widely available, there is often reluctance to prescribe and/or take MHT Good support and communication is crucial Motivational Interviewing approaches can be very helpful for discussing problems and encouraging adherence to treatment CBT c
Slide 37: Thank you!
Thank you! acarepro.abbott.com GLO2159217. August 2020