Living with a Long Term Condition: five ways health coaching can make a real difference
According to NHS England, 26 million people in the UK are living with at least one Long Term Condition (LTC). Just over half of those have two or more. Given these numbers, just what difference can health coaching make? It can have a significant positive impact, as Kate Nash explains.
Coming to terms with a diagnosis for a Long Term Condition (LTC), be that diabetes, heart failure, or Chronic Obstructive Pulmonary Disease (COPD), doesn’t just involve a physical adjustment to spending the rest of your life with your condition. It also requires a massive psychological adjustment too.
Each of those 26 million ‘diagnoses’ represents an individual human story; a life impacted in such a way that it will never be the same again. Every one of those individuals is at present having to come to terms with the impact of their condition, and is having to face up to a future which will be radically different to their past life.
Yes, each individual has a condition which cannot be cured, but which can be controlled and, with medication or other therapies, be managed. But the psychological impact of the diagnoses also needs to be addressed. This, I believe, is where health coaching can make a critical difference.
How to support someone to live well
So just how can we support those with a long term condition to live well? How can we find out what each individual patient would like from the health and care professionals involved in their treatment? What matters now to them in their changed world? And just how would they best like to experience their care? Here are five ways in which we can both address those issues and provide solutions to support each of those individuals manage the new reality of their lives.
In his book, The Lost Art of Healing, eminent cardiologist, Bernard Lown says something very apt for this blog:
The patient desires to be known as a human being, not merely to be recognised as the outer wrapping for a disease.
The best way to make sure you recognise that humanity, and really get to know them, is to listen. Ask yourself these questions:
- When did you last experience someone really listening to you?
- How would you rate your listening ability?
- What is your patient really saying to you?
- Are you listening to reply or to understand?
For those who are living with a long term condition, being heard is vitally important. Health coaching supports you in developing your listening skills which in turn supports your patient. After all, the quality of your listening really does make an impact on your ability to truly respond to what someone is saying: without really listening there can be no real thinking through just how you need to react to what an individual is telling you.
2. New mindset
Coupled with listening is the belief that the person you are working with has potential and has the resources within themselves to realise that potential. You need to believe in them, perhaps, even before they can learn to believe in themselves.
This is the essential mindset of the health coach: that people are very much seen as partners in their care. The patient brings knowledge and expertise about living with the condition, the practitioner brings clinical knowledge and expertise. Together they work to enable the patient to realise their own health and wellbeing goals. As their knowledge skills develop, that in turn increases their confidence.
In this way, health coaching shifts away from the biomedical model. It moves from telling to asking. Through this approach, the patient grows in their ability to manage themselves well.
3. Different conversations
Health coaching is about having different sorts of conversations: those that enable people to identify and talk about what is important to them, but also that support behaviour change.
Health coaching provides structures for conversations about different topics. It involves gently challenging people to think about issues differently, whilst working towards an outcome or action to emerge from this conversation.
Where patients are involved in decision making, they generally have better outcomes, follow more closely the medical advice they have been given, and feel more satisfied. Those different conversations don’t just support patients. It has been found that using such an approach also leads to an increase in practitioner satisfaction.
(see: Personalised Care Institute accessed 2022 https://www.personalisedcareinstitute.org.uk)
4. Fixing or supporting?
If you have any experience of LTCs, you will know that they cannot be fixed. Instead, they need to be managed. However, those of us in the business of health are also used to being in the business of ‘fixing’!
Health coaching supports the patient to change their relationship to the problem or health issue, and supports them in it’s management going forwards. Using open questions and listening skills, you can find out what the patient is already doing to manage their condition. What else could they do? What do they need to understand? What might be getting in the way of, for example, regular monitoring or medication adherence? How will they know if what they are doing is working? What resources or support do they already have?
Health coaching also enables you as the practitioner to share your knowledge and expertise, whilst keeping choice and responsibility with the patient. Just knowing that they have a particular condition is not enough, although it is a great start. Just as important is supporting them to ‘join the dots’ between their behaviour and outcomes. They will spend less than four hours per year with a healthcare professional. That still leaves another 8,756 hrs where they self-manage. A health coaching approach can support them to make sure that they manage those hours on their own equally well.
5. Seeing the whole person
Long term conditions are not just about anatomy, physiology and treatments. Sometimes a conversation supporting a person with their psychological needs is what’s needed. This will be different at various stages of any long term condition.
At diagnosis, a person may experience a range of emotions, and supporting them through the change and transition is important. Health coaching provides structures and skills for this type of conversation, helping support your patient to navigate the sense of loss and chaos, but also moving to a new place of being.
People living with long term conditions are two to three times more likely than the general population to experience issues such as anxiety or depression. How can the patient be supported to create a rich and meaningful life alongside the existence of challenges, pain and suffering? What opportunities arise in consultations for such conversations? What other services do you know about to which the patient could be signposted?
These sorts of conversations may arise at various junctures in the patient’s journey as they live with a long term condition. By seeing the whole person, you can better help them to navigate that journey towards the outcome which is best for them, whatever stage they have reached in that journey.
Making a real difference through health coaching
LTCs account for 50% of all GP appointments and 64% of all outpatient appointments in hospitals. Each of those individuals will, to some degree or other, struggle to come to terms with their condition and the fundamental changes and challenges they will be faced with as a result. When you look at the raw statistics, it may seem overwhelming. How can you possibly make an impact on so many lives? But the fact is you can.
Health coaching, applied in the ways I have outlined above, can not only have a significant impact on the individual facing a future with a LTC, but it can also give you, as a health and care professional, a range of skills and techniques which will support that individual to change how they view their own physical and psychological future for the better. In other words, tools and techniques that help them, but also which enable you to do more to truly address the needs of each and every one of those individuals.
That’s why I believe health coaching really does have the power to make a crucial difference.
To discover more about how to develop your health coaching skills head to the TPC Health website:
Health Coaching for Health & Social Care workforces (tpchealth.com)