One strategy for rheumatologists is to use the time during office visits to uncover the specific reasons for a patient’s anxiety or depression and to encourage them to talk about what’s on their mind.
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Explore This IssueApril 2015
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It’s particularly important to help patients deal with psychological responses to rheumatic disease early on, and it helps to ensure the patient’s spouse or a family member is present during early meetings, according to Michael Weisman, MD, chair of the Division of Rheumatology at Cedars-Sinai Medical Center, Los Angeles. After the initial diagnosis is “a time when the conversation really needs to be completely open,” he says. Dr. Weisman uses humor and storytelling to try to put patients at ease and encourage them to be open about their concerns and to ask questions about their future and potential treatments. Keeping the conversation going during subsequent visits helps bolster patients’ confidence to talk about what’s bothering them, Dr. Weisman adds.
Another strategy is to encourage patients to attend support groups. Support groups have been shown to positively affect the lives of patients recently diagnosed with RA, according to a study at HSS.9 The Early RA Support and Education group includes monthly lectures and peer discussion groups. Lectures are given by rheumatologists, nutritionists, physical therapists, surgeons and other specialists who can each offer their specific area of expertise on the management and treatment of RA. In the discussion groups, clinical social workers and rheumatology RNs co-facilitate to focus “on the unique stresses, psychosocial and educational needs of patients newly diagnosed with RA,” explains Adena Batterman, MSW, LCSW, manager of RA Support and Education Programs, Department Social Work Programs, at HSS. Patients who attend these support groups have reported feeling more hopeful, better able to cope and more confident, and that RA doesn’t feel as disruptive to their lives.
The program at HSS “was developed in a methodical and thoughtful way to ensure that we addressed the unique emotional and educational needs of our patients,” Batterman says. The team started with a needs assessment, distributing questionnaires to patients and conducting focus groups, to identify patients’ most pressing concerns about living with a new diagnosis of RA (e.g., child care, the ability to work, fear of medication), and they conducted literature reviews to ensure the program would be evidence based.
Involving clinicians from several disciplines on the treatment team is key, Dr. Fields says. “You need a multidisciplinary approach to really bring to the patient the group of skills that are needed to deal with both educational and emotional needs.” He adds that specifically including a trained social worker on the team is important because “the social worker is trained in facilitating these groups and to gently guide discussion of patient concerns, and allow people who are quieter to be able to speak, and to run the group in an effective way. Some physicians may have the skills to do this, but it’s not something they’re trained in.”
It’s important to recognize emotional & mental responses to chronic disease. The rheumatologist can refer the patient for help & implement a multidisciplinary approach to help the patient cope.
Taking these concepts into another disease, Dr. Fields is currently investigating education and monitoring techniques in gout patients, who are notorious for poor medication adherence, he says. Ms. Batterman is a co-investigator in the gout study in view of the many psychosocial aspects of medication adherence problems, along with a nurse educator and several pharmacists.