Switching from a daily oral to a long- acting injectable treatment. Young people relying less on their parents and more on themselves to manage their illness.
Switching from an originator biologic to a cheaper biosimilar. These are all examples of the kind of treatment transitions patients experience that can be supported by Patient Support Programmes. In each, clear communication and support is vital.
In these examples, a transition will be ‘successful’ if the patient engages in the new behaviour (eg, taking treatment as prescribed to maximise beneficial effects). Success should also mean patients are satisfied with their care. A number of psychological factors are often at play in any transition.
Some common barriers exist, such as when patients feel as though they have not been included in the decision-making process and are not invested in their decision. This is also true when patients feel they do not have a clear reason for the change. A lack of knowledge and confidence, for example around injections or treatment schedules, can also be a problem, and change often takes people outside their comfort zones.
There are many ways to support patients in these times of transition, guided by evidence-based models such as the Necessity-Concerns Framework and Social Cognitive Theory. For example, clear communication is essential. Presenting a clear rationale for the transition, in a way that helps objectively weigh up the pros and cons of the switch, is vital. Setting realistic expectations is also important; if beneficial effects of a new medication will take time to onset, then knowing this in advance can prevent early discontinuation.
Helping to build confidence is also key. In the example of learning home injection, clear instruction is a good first step, but having the opportunity to observe in person or through videos (modelling), practice, and perform the behaviour under nurse supervision (mastery experiences) all help build confidence in approaching the new.
Transitions to new treatment behaviours can be intimidating for patients, but addressing factors involved in the process can improve both physical and psychological outcomes.
Dr Jonathan Reston, Health Psychology Specialist – Research Manager, Atlantis Healthcare
