Health Coaching as an Intervention for Chronic Disease Self-Management

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Health Coaching as an Intervention for Chronic
Disease Self-Management
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What is Coaching?

• Coaching strives to empower people to enhance
  their own well-being and healing. Coaching
  creates a powerful and effective framework which
  uses the clients experiences, definitions of
  health and wellbeing, and unique needs as the
  starting point for providing EDUCATION, SUPPORT
  AND PRACTICAL SKILLS to enhance quality of life
  and re-gain a sense of autonomy and control.

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Survivorship of integrity, joy, meaning, dignity
and autonomy. (Deena Metzger, Tree)
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Integration of mind, body and spirit.
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KEY AREAS OF PRACTICE
Facilitation Advocacy Documentation System-level
changes Team building
Assessing needs Education Access
Support Co-ordination
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• Comprehensive Health Care

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Evidence of Health Coaching for Management of
Chronic Illness
Linden, A., Butterwoth, M.S., Prochaska, J.O.
(2009). Motivational interviewing-based health
coaching as a chronic care intervention. Journal
of Evaluation in Clinical Practice, 16, 166-174.
Results Compared with non-participants,
programme participants improved their
self-efficacy, patient activation, lifestyle
change score, and perceived health status, and
more participants decreased their stages of
change risk over time than non-participants.
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Butterworth, S., Linden, A., McClay, W., Leo,
M.C. (2006). Effect of motivational
interviewing-based health coaching on employees
physical and mental health status. Journal of
Occupational Health Psychology, 11, 358-365,
358-365.
Results Health coaching is a relatively new
behavioural intervention that has gained
popularity in public health because of its
ability to address multiple behaviours, health
risks, and illness self-management and has been
found to be effective in improving both mental
and physical health.
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EVIDENCE AND EXECTED OUTCOMES

• Increased understanding and knowledge
• Emotional, informational and logistical guidance
• Improved confidence in their decision making and
  ability to play an active role in healing
• More effective communication with health care
  providers
• Improved coping skills
• Improved compliance with treatment
• Improved integration of services

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CONSEQUENCES OF UNMET NEEDS

• Severe emotional distress as a response to cancer
  diagnosis (Andersen, Anderson, deProsse, 1989),
  as well as chronic stress reactions to cancer
  treatments and major life disruptions (Andersen,
  Kiecolt-Glaser, Glaser, 1994).
• Common stressors experienced by cancer patients
  include fatigue, sexual problems, disruptions in
  intimate relationships and social support,
  interrupted life tasks and interpersonal turmoil
  (Spira Reed, 2003).
• Behavioural symptoms related to the distress of
  coping with cancer include appetite disturbances,
  sleep problems, and self-medicating with alcohol
  (Andersen et al., 1994).

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FACTORS THAT ADVERSELY AFFECT RECOVERY

• Lack of knowledge
• Difficulty communicating with doctors
• Difficulty accessing and integrating health care
  providers and services
• Distress
• Sense of meaninglessness or hopelessness

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INDIVIDUALS COACHING EXPERIENCE

• Why health coaching?
• Many individuals know that they need to make
  changes to improve their health and quality of
  life but dont know where to start.
• Coaching helps to provide information about the
  possible changes , break them down into smaller
  pieces, and establish desired goals.

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What are the foundations?We fundamentally
respect the rights of individuals to make
decisions about their treatment and their
health.

• Cancer coaching places the locus of control with
  the individual.
• Their experiences, perceptions, and definitions
  of health and well-being serve as the starting
  point for all interaction.
• On-going feedback is essential for program
  adjustments and to facilitate open communication

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INDIVIDUAL AND GROUP COACHING

• Individual coaching provides one on one personal
  and private time to deal with often unspoken
  fears and concerns. It allows for time to deal
  with unique needs, challenging barriers, and
  establish individual wellness plans.
• Group coaching provides people with the
  opportunity to find support through common goals
  and plans. Synergy between members provides a
  powerful healing modality and members are often
  inspired by each other to create wellness plans
  as supported by a community of peers.

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System of Implementation
Referrals - Members of the centre may self-refer
to the coaching program, or may be referred by
community programs, hospitals, doctors,
complimentary practitioners, community partners
or access to our website of outreach media
campaigns. Intake and Screening Preliminary
one hour appointment to determine suitability of
member and program, to identify needs, and
explain limitations, confidentiality and
expectations. Pre-Assessment orientation apt.
any assessments required Post-Assessment -
ongoing feedback and discussion of needs - any
follow-up assessments.
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Coaching Environment

• Usually 3-6 sessions of approx. 45 min. Phone
  appts, individual and group.
• Individual coaching takes place in private
  suites/offices that deliberately create a
  relaxed, non-clinical environment. Lighting,
  decor, sounds, and smells all contribute to this
  environment.
• Group coaching takes place in either a room with
  large table and chairs or a more casual living
  room-like environment.

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Triage" or Orientation

• Coaching clients first talk to a guest services
  coordinator who walks them through an orientation
  process that includes
• Phone or personal interview to assess basic
  information, screen for distress when
  appropriate, and assess needs as well as explain
  our services.
• This is usually followed by arranging a tour of
  the centre and a group orientation in which they
  register (registration form includes health
  information as well as a needs assessment).

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Who are the coaches?

• Coaches are health care professionals who have
  completed additional training in health coaching
  (i.e.Health Coaching Australia).
• Each professional's expertise forms the
  foundation of their clinical work, but health
  coaching functions as a framework for
  communication, behaviour/perception change, and
  ongoing feedback and goal adjustment.

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Coaching Model

• Step 1. Explain role of coach with emphasis on
  their definitions of health, and your interest in
  assisting them to identify their needs. Discuss
  boundaries, confidentiality, termination
  strategies, if appropriate.
• Step 2. Conversation which allows the patient to
  be heard, and to access their motivation, and
  challenges. Identify issues.
• Step 3. Reiterate and confirm needs and
  challenges. Active listening.

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Step 4. Identify priorities - tap into
motivation. Step 5. Break desired goals/change,
or challenges down into smaller steps based on
priorities. Identify and address potential
barriers. Step 6. Work with individual to
identify pathways to move forward. Step 7.
Identify how the coach can assist with this
movement - i.e. information, support, practical
skills. Reinforce access to personal, medical
and community resources and past successes.
Step 8. Reiterate plan and motivation and
determine next steps - door open for future
work.
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Potential Benefits to Healthcare Providers

• Improved collaboration
• Increased appreciation of interdisciplinary
  cooperation
• Improved satisfaction with care provided
• Improved communication
• Improved productivity of consultation time

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• Improved patient satisfaction
• Enhanced co-ordination between community based
  services and hospital
• Reduction of service duplication
• Improved continuity of care
• (Bruce, 2007 Cancer Care Nova Scotia, 2004 Doll
  et al., 2003 Hohenadel et al., 2007 Psooey et
  al., 2004 Vargas et al., 2008, Canadian
  Partnership against Cancer, 2010).

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Evolving Cancer Care Model by Inspirehealth.ca
Traditional Care
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Inspirehealth Integrative model.
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      I've learned that people will forget what
you said, people will forget what you did, but
people will never forget how you made them
feel. (Maya Angelou)