A Research Paper created by Tom Seaman
(Health and Wellness Coach, UNITED STATES)
When it comes to health and wellness in today’s world, there is an increasing emphasis on self care/management. For individuals with a chronic illness, self care/management is often a significantly challenging task. In many cases, merely getting through the day doing basic tasks, let alone additional activities, is a major undertaking. Thus, maintaining a healthy lifestyle can be quite challenging for people with chronic illness to do on their own. Studies indicate that the assistance of a life coach, people are better able to set realistic goals they can stick to and adopt into their lifestyle. In addition, Primary Care Practices are finding that the more they teach patients about self care, the more effective patients are able to improve their health. Unfortunately, many of these practices do not have trained staff or the time to spend with patients in a coaching/client relationship. As a result, primary care practices are seeing the need to employ life coaches. This paper will demonstrate the need for life coaches in chronic care situations, the benefits for both individual and professional settings, as well as coaching techniques.
Living with a chronic illness can be a life altering experience. Most people can relate to acute pain or some form of temporary limitation when they are sick, but life offers a whole new set of challenges when the condition is chronic, particularly for those who were once in good health.
While life is ever evolving for each and every one of us, adapting to a life filled with pain (mental and/or physical) and debilitation is a situation that offers additional challenges. Often times, support from an outside source is necessary for learning and applying appropriate coping skills. Research has shown that life coaching is extremely effective in helping those with chronic illness become better equipped with self management skills to live productive lives (Kelly, J., Lindner, H., Menzies, D., Shearer, M., Taylor, S. (2003).
As Louma states (Luoma, J. 2012), humans don’t just have pain; they agonize over their painful memories, uncomfortable emotions, and difficult self-evaluations. They worry about them and engage in all kinds of activities to avoid them. They value feeling better, but they do not merely value feeling better. They value a productive life much more than simply a lack of suffering. People want to feel well and make the best of their time on this earth.
Luoma describes an ideal environment for coaching intervention. Coaches are trained to support individuals in living their life to the fullest and engage in productive activities versus activities that promote solitude and avoidance. Learning how to adapt and accept one’s situation is where a supportive coach plays a significant role.
Living with Chronic Illness
People who are stricken with a chronic illness often ask, “why me?” which is a question that cannot be easily answered and thus, can be cause for grief. Many individuals living with a chronic illness often go through the stages of grief, not unlike a person who has lost a loved one. While it may seem odd to compare chronic illness with death, for individuals who develop a chronic condition (Diabetes, Cancer, Fibromyalgia, Parkinson’s Disease, Dystonia, etc.), they have, for all intents and purposes, lost a part of themselves they once knew so well.
The stages of grief include denial, anger, bargaining, depression, and acceptance (Wright, J., 2012). Acceptance is one of the greatest challenges for individuals and also one of the most important to achieve for progress to be made towards living an abundant life. Life coaches are incredible resources for helping clients reach the acceptance stage and find meaning and purpose in their lives.
Since processing the stages of grief can be quite challenging without the assistance of a support system, it is not surprising that there are a multitude of support groups available for practically every health condition and life situation that exists. Clearly, support from others plays a very big role in one’s life. While people who share a similar condition are better able to understand and relate than one who does not, a trained life coach can often provide a different perspective that challenges them to think outside their comfort zone so they can learn to live with less fear and trepidation around their health condition.
When people are able to move past fear and pursue their life passion(s), they are typically more confident, self assured, and motivated to embrace all life has to offer. They realize that they do not have to live with their condition controlling them. They have a choice. It is not the condition that is the most significant thing. It is how they respond to it and learn to live with it. This outlook provides many new and exciting opportunities, and one in which life coaches are well suited to provide motivation and support.
One of the main goals of life coaching is to empower individuals to look within to find tools for living the life they desire. Health coaching is no different. Its only contrast is the clientele with whom coaches are working. In the area of health and wellness, coaching has been defined as an interactive role undertaken by a peer or professional individual to support a patient to be an active participant in the self management of their illness (Kelly, J., Lindner, H., Menzies, D., Shearer, M., Taylor, S., 2003). It is a partnership with patients/clients to enhance self-management strategies for the purpose of preventing exacerbations of their chronic illness and supporting lifestyle change (Huffman, M. 2007). Coaching helps clients change their behavior to complement the new paradigm in their life.
The traditional, allopathic approach is primarily centered on the provision of education directed “at” the patient and family or caregiver. It resembles a teacher giving facts and expecting the learner to respond accordingly. In contrast, health coaching has a focus of special issues and concerns unique to the individual patient that fit into the context of the patient’s life (Disease Management Advisor, 2005).
Educational materials are appropriate to use, but the role of a coach is not to diagnose and/or educate clients about their condition, or determine their overall goals based on their condition, but rather, what the patient actually states their goals to be. Coaches actively engage and guide the patient through the process of changing their behavior. They are facilitators who help the patient and caregiver to achieve their health-related goals (Huffman, M., 2007)
Hunt, Joseph, Griffin, Hall, and Doherty Sullivan (2001) state that, “coaching differs from teaching in that the coach is not placing emphasis on imparting new ideas but rather focusing on supporting others in their efforts to reach a new goal” (p. 704). This comment clearly explains the process whereby the patient is actively selecting and pursuing new goals and the coach is supporting that process.
In order for chronic care management to really be successful, behavior change on the part of the patient is critical, and the traditional model of a physician or provider telling the patient what to do has not been working (Disease Management Advisor, 2005). Coaches do not tell people what to do. Instead, coaches work in a collaborative manner with clients to help them find the skills and confidence to be able to make the changes they want to have happen.
There are a variety of approaches coaches can take when working with individuals with chronic illness. Regardless of the approach taken, the key goal in health coaching is to enhance the well-being of individuals and help facilitate the achievement of their health-related goals. (Disease Management Advisor, 2005). Health coaching effectively motivates behavior change through a structured, supportive partnership between the client and the coach. The coach helps the client clarify goals and provides insight into goal achievement through inquiry, collaboration, and personal discovery.
Effective chronic illness care requires 2 things:
1. Actively involved patient and caregiver
2. Healthcare team that centers on the patient and caregiver
Coaches must connect with the patient and caregiver on the basis of patient goals, not their own, because he or she is the ultimate decision maker. The focus of a coach should be on what is important to the patient, what the patient wants to accomplish relative to the disease or condition he or she has, and how active the patient is in caring for themselves. Making the patient the center of our efforts puts the patient’s needs, concerns, and goals at the center of how we address them, how we respond to them, and how we focus our efforts.
Miller and Rollnick (1990) suggest a strategy they call the OARS technique, a technique that keeps the patient moving forward by facilitating discussions about change.
The acronym stands for:
- O pen-ended questions
- A ffirmation of the person's strengths
- R eflective listening
- S ummary
Open-ended questions allow the patient to focus on his or her concerns at the time.
Affirming the patient’s strengths validates the internal and external resources upon which the patient can draw going forward. This helps the patient feel confident that goals can indeed be met.
Reflective listening demonstrates that your purpose is to be “interested,” not “interesting.” It is vital to carefully listen for underlying concerns that may come from the patient or the caregiver and to delve deeper as the patient allows or is ready.
Summary allows the coach to reiterate the main points shared by the patient and to verbalize an interest in the patient’s concerns.
It is always better to help the patient arrive at their own solution. This keeps the conversation centered on the patient and what is most helpful to the patient. Only then can patients and caregivers feel empowered with support and guidance as needed to make progress toward the goals most important to them.
Ossman (2004) suggests that a productive interaction should:
- Elicit what the patient identifies as the problem
- Provide appropriate information
- Elicit the patient's reaction to the information
This technique is similar to OARS in that the patient’s identification of the problem comes first, followed by the giving of health information relative to his or her concerns. Finally, the coach listens to the client and observes his or her response. The focus, like OARS, is “all about the patient” (Ossman, S., 2004). While there are similarities to the OARS approach, this type of interaction also involves teaching and consultation which is outside the realm of the traditional coaching model. While teaching and consultation are typically not part of the coaching process, they can certainly be utilized when appropriate as long as it gets patients/clients moving closer to their personal goals.
Funnell (2000) recommends that healthcare professionals start with comments such as, “Tell me what bothers you most.” “Tell me what is hardest for you.” “Tell me what you’re most distressed about.” “Tell me what you most want to change.” This helps the clinician get to the core of what is most important to the patient or caregiver, and provides the best place to start making inroads to behavior change.
While these are powerful questions, primary care practices are overburdened with patients that clinicians are unable to spend enough time with each patient to address these issues. In addition, they often lack in-house experience to successfully help initiate an infrastructure to support such an approach. Primary practice (health) coaches are better suited to work with patients in this capacity. The presence of a coach lends structure, dedicated time, and focus to quality improvement efforts (Coleman, K., Pearson, M., Wu, S. 2009).
Coaches can play the following roles in a primary care practice:
- Facilitators who help practices achieve their improvement goals
- Bring groups of staff members together to work through an issue
- Help practices prioritize their change activities and keep them on track
- Sounding boards who give practices a reality check and provide feedback
- Problem-solvers who can help practices identify and surmount a stumbling block
- Change agents who promote adoption of specific evidence-based practices
- Direct interaction with patients to provide ongoing support
Based on the evidence provided, it is clear that life coaches are gaining greater respect and being recognized for the valuable skills they offer to individuals with chronic illness. This is a very positive indication for the future of coaching and the multitude of individuals and groups of people with chronic illness who will be helped by the coaching profession.
Coleman, K., Pearson, M., Wu, S. (2009). Integrating Chronic Care and Business Strategies in the Safety Net: A PRACTICE COACHING MANUAL. Prepared for Agency for Healthcare Research and Quality U.S. Department of Health and Human Services. Retrieved January 23, 2012 from www.ahrq.gov.
Funnell, M. (2000). Helping patients take charge of their chronic illnesses. American Academy of Family Physicians. Retrieved January, 23, 2012 from www.aafp.org.
Huffman, M. (2007). Home Healthcare Nurse, Health Coaching: A New and Exciting Technique to Enhance Patient Self-Management and Improve Outcomes, 2 (4), 271-274.
Hunt Joseph, D., Griffin, M., Hall, R., F., & Doherty Sullivan, E. (2001). Peer coaching: An intervention for individuals struggling with diabetes. The Diabetes Educator, 5, 703-710.
Kelly, J., Lindner, H., Menzies, D., Shearer, M., Taylor, S. (2003). Coaching for behavior change in chronic disease: A review of the literature and the implications for Coaching as a self management intervention, American Journal of Primary Health, 9 (2&3), 1-9.
Luoma, J. (2012) Acceptance and Commitment Therapy (ACT), Retrieved January 22, 2012 from http://www.drluoma.com/ACT.html
Miller, W., & Rollnick, S. (1990). Motivational interviewing: Preparing people for change . New York: Guilford Press.
Ossman, S. S. (2004). Motivational interviewing: A process to encourage behavioral change. Nephrology Nursing Journal, 31 (3), 346.
Time crunch: PCPs swamped with chronic care management. (2005). Disease Management Advisor, 11 (7), 73–78.
Wright, J., (2012) Kubler Ross Stages of grief. Retrieved January 22, 2012 from http://www.recover-from-grief.com/kubler-ross-stages-of-grief.html.