The curtailment of recreational pursuits and peer-group activities will further erode one’s sense of normality. The clinician would do well to inquire about the patient’s self-esteem so that measures may be taken to fortify the patient’s self-perception, as needed.
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Explore This IssueMay 2017
Motivation to engage in self-management strategies—Traditionally, patient education focused on the disease process, and technical skills were taught to better manage the disease.19 Additionally, the clinician reinforces understanding about the diagnosis and the available options for treatment. This type of patient education remains an essential component of care for a young adult rheumatology patient. However, young adults also require active involvement in their own health decision making to increase their confidence and resourcefulness for self-management.18
The underlying principles and critical skills for self-management of chronic illness are well documented.20-22 Essentially, self-management education teaches patients the skills to self-identify problems of living with chronic illness and how to use a process to solve those problems. Interventions that increasingly put the responsibility for chronic disease management onto the patient by enhancing self-efficacy, coping skills, social support and follow-up plans positively impact health outcomes.23
However, for a self-management strategy to be effective, the young adult must be motivated to actually work on the tasks that will lead to living well with a chronic condition. By using a task-centered approach, the clinician will be able to assess the young adult’s willingness to work on the problem to achieve a desirable goal.24,25
Tips for Improving Communication
A clinician who starts a session with excessive questioning and standardized treatment protocols runs the risk of enduring long silences. This is because young adults tend to be highly protective of their emerging selfhood and, therefore, loathe disclosing anything of a personal nature to someone who comes across as overbearing and has yet to earn their trust. The appearance of talking down to the patient or assuming a verbal one-up stance threatens the patient’s vulnerable sense of dignity.26 However, breaking the ice is easily expedited if the clinician conveys respect and authenticity.
Respectful relating—Respectful relating requires the clinician to engage the young adult patient with a little small talk before proceeding to questioning. Regularly soliciting young adults’ feedback allows them to feel respected as an individual because their voice is being heard. It has the additional benefit of tapping into the opinions held by this cohort on symptomatology, treatment and lifestyle issues.
Perhaps most importantly, the clinician must convey it’s understood that the patient is fully capable of making their own decisions around treatment choices. That is, the young adult is being notified that help is being offered, but the decision to accept help is entirely their own, and that decision will be honored.