When health care professionals address the social and behavior aspects of a patient’s life as part of medical treatment plans, they can improve patient survival and longevity.
Providing patients with support that involve families and promote health behavior gave patients a 29% increased probability of survival over time, according to a BYU study just published in the journal PLOS Medicine.
Researchers analyzed data from 106 randomized, controlled trials — more than 40,000 patients in all — to see how or if interventions like support groups and family sessions that target healthy behaviors change patient outcomes.
Timothy B. Smith, the study’s lead author and BYU counseling psychology professor, said those types of supports, called “psychosocial support” are under-used in health care, but the study validates that they can improve patient survival — so key that he likened the impact of psychosocial support to the importance of cardiac rehabilitation or stopping smoking for someone with heart disease.
He said the intervention starts with a simple question providers can ask patients: What kind of support do you have to help you manage this condition we’re talking about today? And then figuring out how to bolster those existing support sources, perhaps by inviting family members to the next appointment or connecting someone to a counseling program.
Medical providers aren’t doing as much as they could to help patients if they’re only diagnosing and providing medical treatment, he said. They could have dramatically better results if they included supports like inviting family members and caregivers to be part of the treatment process.
One of the studies researchers looked at, for instance, showed training family members to do spinal cord injury rehabilitation in the home extended about 10% of the patients’ lives.
“That’s remarkable,” Smith told the Deseret News. “Most medications don’t extend life by 10% of survival rates.” The goal is to support patients emotionally and help them behaviorally cope with their disease.
Other psychosocial supports they looked at included interviewing the patient to learn the individual’s motivation and identify barriers to treatment, relaxation training or counseling, support groups, sessions with family members that target healthy behavior and coordinating home visits with nurses and others. All of these can include family members or other caregivers.
“We already have robust evidence that social connection and other social factors significantly influence health outcomes including risk for premature mortality, but it was unclear what can be done about it to reduce risk,” BYU psychology professor Julianne Holt-Lundstad, a study co-author, said in a study news release. “Is it the role of health care, or should it be addressed outside the health care system? This research combined with the other consensus reports suggests that it is the role of the health care system.”
Vital teamwork
The researchers believe health care collaboration is key, especially between medical and mental health providers, since about half of patient visits are for conditions that also have psychological factors.
Smith said the psychosocial interventions can reduce stress that may interfere with treatment or well-being by giving patients new ways to cope so they can move forward. Connecting patients with others with similar conditions “kind of normalizes the situation” and allows patients to share ideas about how they manage their disease.
“Most people don’t know someone with kidney disease, but once you get it, you start to know others. You can share information, what works for them and try those things. When you get discouraged, you have people that you can fall back on,” Smith said.
Families are key to helping most patients manage an illness. And involving them only makes sense, but health care providers don’t always do it. Smith said people are perhaps more aware of how important family connection to care is as the pandemic separated people from ill loved ones. COVID-19 highlighted how much family members want to be with patients and how much patients long to have them near, said Smith.
Because of the enforced isolation to stop the spread of COVID-19, Smith said, his family could only watch through the window as his father-in-law died recently. Many families had similar experiences. “But as soon as this is over, hospitals will need to reboot,” he said. “They’ve been so used to excluding people — and we know from prior research that actually is harmful, on average, if transmission is not an issue. Patients need the support of families. And families need that, too.”
Hospitals that are family-friendly in policy and practice will see better survival rates long term, Smith predicted.
It’s not all on the provider, though, to work with families, he added. “Many patients’ families have become overly demanding or intrusive. So it has to be a mutual relationship of respect where the family members respect and abide by the expertise, the time, the space, the kind of boundaries of the health professionals. You are there to visit and support the patient, not get in a nurse’s way. Both sides need to recalibrate,” said Smith.
Patient-centered care
In cases where a patient cannot travel and a nurse visits the home, patients are helped more if a nurse doesn’t just do a checkup, but listens and helps work through the ill person’s emotional concerns.
Person-to-person contact matters, but it need not be in the same room, as telemedicine has proven during the pandemic.
A study in Germany showed phone calls were effective. A nurse would periodically check in and just offer emotional support. Smith said it was a “remarkably efficient” way to extend and even save lives. Handing someone a brochure doesn’t work.
Tools like asking about a patient’s motivations and barriers to treatment are increasingly being taught in health care training programs, according to Kathie Supiano, associate professor in the University of Utah College or Nursing and director of “Caring Connections: A Hope and Comfort in Grief Program.” She was not involved in this study.
Supiano’s career has included both clinical practice and training other health care providers and she said use of psychosocial interventions is key for patient outcomes.
Patients choose if they want the family involved. Most do, and it usually helps, she said “We know that if we want to bring psychological change and particularly change in health behaviors, we really need to get the family, the social network involved in a way acceptable to the patient.”
But not all involvement is productive, she adds. A nagging spouse won’t lead a smoker to stop, even if it’s done out of love.
Health care providers must determine if a patient understands the diagnosis and recommendations if interventions are to work. A patient who’s anxious or in pain may not be able to listen and understand. The same is true for a family that’s exhausted, Supiano said.
But the task most important to improve outcomes is keeping the patient’s goals at the center of his or her care. It boils down to what matters most to the patient and how providers and others can help reach whatever the end goal is, usually one step at a time, she said.
A dying patient might want to make it to a granddaughter’s graduation at the end of summer or visit a favorite place once more. “We would start developing psychosocial interventions that optimize health behaviors and help them reach that goal,” she said.
Changing health behavior and improving outcomes works best when it’s active, not passive like a doctor saying, “Matt, you need to lose 50 pounds,” Supiano and Smith both said.
“We have to start where the patient is,” said Supiano.
An adult daughter might predict that “it would kill my mother if she had to go into a skilled nursing home.” But Supiano said the mother might say, “If I can get physical therapy twice a day there instead of once a day, then I can recuperate faster and I would agree to that.”
She said that time spent up front on psychosocial considerations saves time and money in the long-term, while improving patient outcomes.
Hospitals, clinics and individual practitioners may need to formalize policies, then put them into practice. The BYU research team, which included about 20 students who worked for multiple years on the study, said medical practices and facilities should be more family- and caregiver-friendly. Some may need to improve how they train staff in social, emotional and behavioral considerations, integrating aspects in pretreatment planning, follow-up and rehabilitation.
While response to a diagnosis varies, patients do have higher rates of depression and anxiety than the general population, which can hamper treatment decision-making.
Smith said he hopes that health care providers all learn to routinely listen to patient concerns, help reduce stigma and ask for help if they have barriers that might keep them from following treatment plans.
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