Engaging and Educating Patients and Families

Retention in treatment is key to successful long-term patient outcomes.¹ Patient-provider relationships are critical to keep patients engaged in treatment, particularly in the first few weeks or months when a patient is still stabilizing. Providers need to carefully consider how to build patient-provider relationships to establish trust and a therapeutic alliance. Use communication styles or strategies that demonstrate that the program has an open, honest environment free of judgment, such as:²

• Be empathic and warm;
• Treat patients with respect and make them feel understood; and
• Do not let personal opinions or feelings influence patient interactions.

For example, as discussed throughout the Playbook, motivational interviewing can help patients make positive changes in their lives. Motivational interviewing is an approach to discussions that can draw out a patients reasons for changing and strengthen their motivation. The main principles of motivational interviewing are³:

• Collaboration vs. confrontation—work together to develop a mutual understanding rather than arguing about who is right.
• Drawing out vs. forcing ideas about change—do not try to convince someone to change, rather try to draw out a persons own motivations and reasons for change.
• Autonomy vs. authority—recognize that ultimately it is up to the individual to make a change.
• Roll with resistance—resist the urge to correct or argue with people who resist treatment suggestions or other advice. Rather, keep listening and let them come up with their own ideas for change.

Sample questions to ask when using motivational interviewing techniques can be found in the Resources section below.

All staff should also be aware of the language they use and the impact it can have on a patients experience. For instance, words such as addict or drug abuser can reinforce stigma toward those with OUD. Rather, staff should use person-centered language. Staffs language and attitudes play a large role in how patients perceive the atmosphere of the practice. Patients will be more engaged and more likely to remain in treatment if they feel welcome. (See the Train Staff on Patient Engagement to Create a Welcoming Environment section.)

Shared decision-making is when a health care provider and a patient work together to make a health care decision that is best for the patient. The optimal decision considers evidence-based information about available options, the providers knowledge and experience, and the patients values and preferences.²

Engaging patients in choices about their treatment can help establish trust and build the relationship between patient and provider. Also, when patients take an active role in the decision-making process, they understand better what they need to do and are more likely to follow through.² You do not need to agree with patients decisions, but it is important to respect them.²

The following quotes illuminate patients feelings about shared decision-making (when given the choice between three different buprenorphine initiation protocols):⁴

In addition, communicate with patients, families, and their caregivers in a manner that respects their unique culture, language, and health literacy. Culturally competent services can help improve patient outcomes and minimize health disparities by recognizing how culture influences behaviors and attitudes, including how some may seek and engage in health care. In particular, understanding a patients health literacy and tailoring language or materials accordingly can be key to effective communication.

Taking a risk reduction approach to risky patient behaviors can also encourage patients to stay in treatment. Adopt program policies and use strategies to reduce morbidity and mortality associated with opioid use among individuals for whom abstinence is not an immediate or feasible goal. This approach conveys to patients that you are not judging them for their decisions but rather want to keep them as safe and healthy as possible.

Stigma may be one of the biggest barriers to engaging patients in treatment. While staff will have already received training about OUD and its treatment to help dispel stigma, it is important that providers offer basic education to patients, families, and other important persons in patient's lives. Support of family and friends can be very important to sustaining ones recovery. This education can help build support among family and friends and can help patients and their families advocate for themselves and their loved ones.

Be proactive in dispelling myths or misunderstandings about medications for OUD or addiction when they hear them²⁵ and educate patients and family members about what to expect at each stage of the treatment and recovery process. This education should emphasize the following points:

• Medication is an effective treatment for OUD;
• Addiction is a chronic, recurring brain disease;
• Recovery is an achievable goal; and
• Remaining on medications for OUD long-term leads to better patient outcomes.

Education should also cover topics such as how medications for OUD work, medication side effects, the risk of setbacks and recurrence of use, overdose interventions (i.e., administration of naloxone), and related topics. Learn more about how to Prevent and Respond to Recurrence of Use.

It is important to identify patient- and family-oriented educational materials that are consistent with the practices approach to patient care. These materials can be a good source of information for patients who want to learn more on their own. See the Resources section for examples of such materials.