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stages_of_change_article - A'Stages of Change Approach to...

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Home Page > News & Publications > Journals > American Family Physician ® > Vol. 61/No. 5 (March 1, 2000) Advanced Search Remember Me Log - in Help ID Number Last Name/Password A 'Stages of Change' Approach to Helping Patients Change Behavior GRETCHEN L. ZIMMERMAN, PSY.D., CYNTHIA G. OLSEN, M.D., and MICHAEL F. BOSWORTH, D.O. Wright State University School of Medicine, Dayton, Ohio Helping patients change behavior is an important role for family physicians. Change interventions are especially useful in addressing lifestyle modification for disease prevention, long-term disease management and addictions. The concepts of "patient noncompliance" and motivation often focus on patient failure. Understanding patient readiness to make change, appreciating barriers to change and helping patients anticipate relapse can improve patient satisfaction and lower physician frustration during the change process. In this article, we review the Transtheoretical Model of Change, also known as the Stages of Change model, and discuss its application to the family practice setting. The Readiness to Change Ruler and the Agenda-Setting Chart are two simple tools that can be used in the office to promote discussion. (Am Fam Physician 2000;61:1409-16.) O ne role of family physicians is to assist patients in understanding their health and to help them make the changes necessary for health improvement. Exercise programs, stress management techniques and dietary restrictions represent some common interventions that require patient motivation. A change in patient lifestyle is necessary for successful management of long-term illness, and relapse can often be attributed to lapses in healthy behavior by the patient. Patients easily understand lifestyle modifications (i.e., "I need to reduce the fat in my diet in order to control my weight.") but consistent, life-long behavior changes are difficult. Much has been written about success and failure rates in helping patients change, about barriers to change and about the role of physicians in improving patient outcomes. Recommendations for physicians helping patients to change have ranged from the "just do it" approach to suggesting extended office visits, often incorporating behavior modification, record-keeping suggestions and follow-up telephone calls. 1-3 Repeatedly educating the patient is not always successful and can become frustrating for the physician and patient. Furthermore, promising patients an improved outcome does not guarantee their motivation for long-term change. Patients may view physicians who use a confrontational approach as being critical rather than supportive. Relapse during any treatment program is sometimes viewed as a failure by the patient and the physician. A feeling of failure, especially when repeated, may cause patients to give up and avoid contact with their physician or avoid treatment altogether. After physicians invest time and energy in promoting change, patients who fail are often labeled "noncompliant" or "unmotivated." Labeling a patient in
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