Compliance or success? Communication is key
By Penelope Morrison Bosarge, RNC, CRNP, MSN
Women’s Health Nurse Practitioner
Teaching Faculty, Graduate Programs
University of Alabama School of Nursing
Birmingham
How do we describe performance when it comes to helping patients manage their menopausal symptoms? Let us first consider replacing the term "compliance" with "success." This suggestion comes from Susan Wysocki, RNC, NP, president of the Washington, DC-based National Association of Nurse Practi- tioners in Reproductive Health. She offers it in light of the many facets of hormone replace-ment therapy (HRT).
"Noncompliance" carries negative undertones of orders not being followed and of disempowerment. On the other hand, "successful" offers a more positive connotation and suggests that goals have been met.
Webster defines compliance as obedience, acquiescence, and submissiveness, while success is defined with terms such as accomplishment, achievement, and attainment. I agree to take this suggestion and use more positive attitudes with women that will empower them to be successful in their goals for healthy lives.
Success: What does it mean?
Who will set the measurement in determining if a patient is successful? Success can be found anywhere on a continuum, depending on whose perspective is considered. At one end of the scale is the woman who begins HRT at the first rise of follicle-stimulating hormone, takes it faithfully, and follows a health maintenance program with diet and exercise. On the other end of the spectrum is the woman who decides against HRT and chooses not to participate in a health maintenance regimen. Both of these women are quite happy with their decisions.
Who is successful? I propose that success is a measurement of the woman’s perception of it. Since we have a wide array available of possible regimens and programs, we can customize a course of treatment to help achieve patient satisfaction.
As a clinician, you may not understand why a patient does not "follow orders," especially with the wealth of information in the media related to menopause. Women are indeed battling information overload, trying to distinguish the accurate from the inaccurate.
Much of the scientific data surrounding the subject is contradictory, suggesting that we in the medical field are confused as well. Do we really expect women to interpret and understand this information when we are struggling to find the answers? As Felicia Stewart, MD, director of reproductive health programs for the Menlo Park, CA-based Kaiser Family Foundation, points out, "The questions remain the same; it is the truth [answers] that keep changing."
When it comes to HRT, fear of breast cancer, dislike of side effects, and a lack of information may present barriers to its use. Many patients do not believe in taking medications they view as unnecessary. They do not understand the preventive maintenance rationale and would rather treat problems as they arise.
It is important to offer careful, basic information in understandable, jargon-free language when discussing any course of treatment. If we do not do so, the following may occur:
• Women may not get interventions that could extend their lives or relieve immediate symptoms.
• Women may rely on unreliable information in their decision making, which may not help and might even cause harm.
• As clinicians, we may see the deterioration of our practices from unhappy patients who do not perceive their needs as being met.
How to encourage successful outcomes
How can you set the stage for helping your patients successfully manage menopause?
• Provide an office atmosphere conducive to discussion of any issue, including those unrelated to procedures and treatments.
• Make sure staff members take part in continuing education so they can provide consistent, accurate data.
• Use pre-visit counseling to save office time for discussion and education. Printed information on menopausal issues can be mailed prior to the office visit. A self-administered history and menopause symptom assessment test also can be completed at home, leaving more time to concentrate on the issues that have been recognized as important by the patient.
• Stay current on printed and broadcast women’s health news. Look at the literature your patients are reading, such as popular women’s magazines and so-called "wonder cure" self-help books. Be prepared to correct misconceptions and give accurate information.
• Initiate discussions on sensitive issues such as vaginal symptoms and libido. Invite the partner to counseling sessions if the patient so desires.
• Open the discussion to psychosocial issues that may present problems in menopause. Be aware of social agencies or self-help groups that can provide support.
• Schedule follow-up visits in which overlooked issues can be discussed. If HRT is chosen, periodic monitoring is necessary for adjusting dosages as well as addressing side effects and concerns.
Encourage success in your practice. Be prepared to provide various treatment options, management, and counseling, all of which can be combined into programs with attainable goals. By working together to identify and set these goals, success can be achieved.
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