Improving the Quality of Physician Counseling for Behavior Modification

Although little direct evidence exists from randomized trials to inform us of the best ways to counsel patients to modify health behaviors, much can still be learned and applied from the available evidence. The way that a doctor communicates with a patient has a strong influence on patient satisfaction and patient adherence. There are several communication patterns in particular that appear to lead to positive outcomes. First, patients whose physicians encourage them to participate actively in their medical treatment decisions have improved health outcomes.109-112 Second, building rapport, through a discussion of psychosocial issues that help the physician understand the "whole person," is associated with improved patient satisfaction and adherence to physicians' recommendations.113,114 Third, providers who support motivations that are initiated by patients, also known as being "patient centered," have patients who are more satisfied with their care and who take a more active role in their care and have better outcomes.110,114,115 Regardless of the interaction, these communication patterns are best to employ whenever possible. This is particularly true of health behavior counseling, which can be stressful for both the doctor and the patient, given patient resistance to change and the overall low likelihood of success of behavior change.

A commonly used framework for organizing brief behavior counseling is the "5 A's"116,117: "Address the Agenda," "Assess," "Advise," "Assist," and "Arrange."47 We try to highlight these five activities and the previously mentioned communication patterns in a case study, adapted and reprinted with permission.63 This case study is related to diet, but the process (the 5 A's) are the same for changing any health behavior.47,117-119

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