Key learning points
- It is important to make the most of the time with patients in a consultation to optimise outcomes
- Patients want to be more involved in their care and appreciate a shared decision-making approach
- Motivational interviewing techniques, personalising care and cognitive behavioural therapy can all be useful tools in the respiratory consultation
Many clinicians would agree that time pressures can sometimes impact on the quality of care we would like to provide to our patients. It is essential, then, that we all make the most of our time with patients to optimise outcomes. The focus on meeting the Quality and Outcomes Framework (QOF) agenda can sometimes detract from delivering a tailored consultation that meets the needs of the patient, and yet it is possible to do both.
ICE consultation model
A helpful start to any consultation is to remind the patient that we have a finite amount of time together, so it would be useful to know if they have any specific concerns that they would like to address within this time. This fits with the ICE consultation model, where ICE stands for ideas, concerns and expectations.1 The individual is invited to share their ideas about their condition and any concerns they may have, along with the expectations they might be harbouring as to the outcome of the consultation. An example of this is changing their inhaler device or being sent for a chest X-ray. Even if their expectations are inappropriate, identifying them can allow them to be aired and discussed.
The 2014, the King’s Fund report People in control of their own health and care indicated that patients wanted to be more involved in their care and that they valued a shared decision-making approach.2 Focusing the consultation on ICE may increase the likelihood of the patient feeling as though they are being listened to and involved in their consultation.
QOF requirements can also be met using ICE as the basis of the consultation. For example, if the individual says that they have concerns about exercise-induced symptoms or night-time symptoms, it would be entirely appropriate to check their inhaler technique, discuss adherence and measure peak flow rate, all of which will feed the QOF template, while still maintaining a patient-focused review.
Motivational interviewing techniques can also be valuable in respiratory consultations.3 A useful question that allows people to think about what they would like to change with regard to their respiratory care might be: ‘What do you dislike most about having asthma/COPD?’.
Being able to understand this issue might help the clinician and patient to work together to personalise the package of care. For example, they might agree to switch to a more appropriate device, change asthma treatment from an inhaled corticosteroid (ICS) alone to an ICS with a long-acting bronchodilator, or add a leukotriene receptor antagonist. A patient with COPD might find that productive cough is the issue that troubles them most and stops them going out socially; a long-acting muscarinic antagonist might be a suitable option. By simply asking people what they’d like to change, you can work together to make that change happen.
Cognitive behavioural therapy
Similarly, cognitive behavioural therapy (CBT) can help people to take a different view of their respiratory symptoms, especially in COPD.4 Breathlessness can be a frightening symptom, leading to activity avoidance, which will in turn lead to deconditioning.5 Encouraging people to reconsider their approach to managing their symptoms, for example, by avoiding physical activity, can help.
It might be useful to ask patients what matters most to them when you next carry out a consultation and then work to their agenda. The key areas that have been shown to impact on respiratory outcomes include being on optimal treatment and using good inhaler technique, having an action plan and attending reviews.6 Having ‘open plan’ consultations which focus on the needs of the individual and ensure that they feel at the centre of all decisions increases the likelihood of them feeling that their time is well spent attending their reviews, which are not just a tick box exercise.
Beverley Bostock, education lead and clinical specialist, Education for Health
This project was initiated and funded by Teva Respiratory. Teva have had no influence over content. Topics and content have been selected and written by independent experts.
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