Your skills for an effective conversation

Whenever attempting to change patients’ behaviours, healthcare practitioners need to be able to explain the benefits and gains to their patients and contrast it with the losses so that these can be tangibly assessed. For example, outlining the key benefit of reducing the chances of the patient or family members getting ill compared to the disadvantages of not getting the vaccination such as days off work or worse.

The way choices and options are presented to individuals effect the way they make decisions.

It is not TELLING it is EXPLAINING.

Instead of tussling with the patient when they are hesitant or even reject the offer of vaccination, using a motivational interviewingapproach will increase the likelihood of the patient reconsidering their stance.

The key to making the above effective is having a conversation that is open-ended, with non-judgemental listening and in a positive communication style. That is MOTIVATIONAL INTERVIEWING.

The most important aspect of any Motivational Interview/ Brief Intervention is ‘Gaining permission.’ Raise the issue or look/listen for ‘triggers,’ allowing you to capitalise on the opportunistic moments to discuss the flu jab is the key at your appointments. Stick to open questions that will allow you to create a discussion. Remember it is how the information is provided, not what information is given, that is key to creating a positive outcome.
If you are finding it difficult to engage with your patient on the topic then using affirmations might be of an advantage. e.g.’ I can tell you’re busy and you’ve got to get home, but thank you for coming to your appointment today…’ ‘Thank you for attending your appointment, apologies for the wait and I appreciate that you need to get going… but can I discuss…’ ‘I can tell you’re not sure about the vaccine, and you’re not alone in that, but I’d like to give you some information and hopefully remove the concern or myths you might have heard.’ ‘I really appreciate your honesty’ ‘Thank you for sharing your concerns’ Affirmations are recognitions of strength, quality, effort, and ability. It is an appreciation of what the individual’s views/barriers are and shows that you care and are genuine when it comes to the patient’s health.
If you are developing a rapport with the patient and the open questions are providing an effective and engaging discussion then take the opportunity to provide advice and some relevant background information/recent research on the vaccine. Making sure that you are using a key skill here and an important element of MI/BI, reflective listening Here you should use words that emphasise that you’re listening… ‘So what you’re saying is... that you’ve heard about?’, ‘Can I just check that what you’re saying is?’, ‘You mentioned that..?’ Listening well and reflecting back what you’ve heard helps to clarify information and leads to greater exploration.
The final piece to the MI/BI jigsaw is summarising. Summarising in a nutshell is an opportunity for you to relay back what you’ve heard over the course of the appointment. ‘I remember what you told me and I just wanted to relay it back so that it all fits together’ ‘So here’s what you’ve told me so far...’ ‘Can I just check that I’ve captured everything?’ Summarising allows you to complete an appointment effectively. It is an important tool to use, regardless of what the topic of discussion is in your appointments. It will provide yourself and the patient a chance to ensure that you haven’t missed anything out and fulfil a comprehensive and positive conversation.

Exit strategy

In view of all the information we provide on how to generate and develop positive and collaborative discussions with your patients, it is just as important to have an exit strategy in place.

An exit strategy allows you or the client to finish the conversation at any time. This is a very useful tool to have and should not be looked at in a negative way. Ending a conversation with your patient who you were hoping would be able to see your point of view and understanding the reasons behind being vaccinated but failed to do so, is of course difficult and would seem to be a negative outcome.

If you have had a conversation where you have followed the MI/BI techniques, you have generated a discussion that has been collaborative and patient centred but has not produced a successful vaccination, then an exit strategy is vital as this will close the conversation effectively and professionally.

Keeping an 'open door', allows the opportunity for it to still be an engaging and positive discussion regardless of the outcome.

Changing behaviours and influencing change in an individual's opinions/views can be very difficult, especially with patients who might have had negative experiences or heard misinformation and concerns around the flu vaccine.

The exit strategy is a useful tool in regards to still potentially supporting the patient to receive a vaccine. They might require further reading or are genuinely time restricted at that specific moment, but you can leave the conversation with a positive ending.

"You've mentioned that you haven't thought about the vaccine that much, but you did say you'd like further information on it. If we leave the conversation there, but please take this leaflet and get back to us when you've had further thought?"

"I know you mentioned that you were restricted for time today, but you would like to receive the vaccine following our conversation today which is great. If can book you in now for the.... Next week and we will do it for you then"

GAINING PERMISSION

Gaining permission from the beginning helps patients feel at ease, gives them equal status in the consultation and the opportunity to say no.

“Is it ok if we talk about…?”
“Do you mind if I ask…?”
“Would it be ok to discuss…?”

RAISING THE ISSUE

Advice given by health professionals is important but how it is “given” is even more crucial. Asking open questions will give you more information and allow for conversation;

“What has made you want to have the vaccination?”
“It sounds like you’re interested in hearing a bit more. How do you feel about us doing that?”
“You mentioned that you’re a carer for a relative, let’s have a chat about the effect of influenza on them, shall we?”

Or more direct;

“How do you feel about the vaccination today?”
“What do you know about the vaccine?”
“What concerns do you have?”

OPEN QUESTIONS

Closed questions lead to a yes-no response, open questions will give you more information.

- “How do you feel about the flu jab?”

- “What concerns do you have with the vaccine?”

- “What are the reasons for you to receive the vaccine today?”

LISTENING WELL

Listening well and reflecting back what you’ve heard helps to clarify information and leads to greater exploration/

“So what you’re saying is…”
“Can I just check…?”

EXPRESSING EMPATHY

Empathy is not sympathy, pity, warmth, acceptance or identification.

Empathy is showing an active interest in and effort to see the world through their eyes. It is exploring opinions and ideas about the behaviour with accurate reflection.

“I understand that you have some concerns about the vaccine…”
“It seems to me that you are feeling unconvinced about whether the vaccine is for you…”