Aufgrund ihrer klinischen Symptome, ihrer Persönlichkeit oder der auf Health Care Practitioners (HCP) ausgeübten psychischen Belastung können einige Patienten in der klinischen Praxis durchaus zu Recht als „problematisch” bezeichnet werden. Häufig lässt sich für deren Schmerzen oder funktionelle Einschränkungen keine biomedizinische Erklärung finden. Sowohl die Berücksichtigung aktueller Forschungsergebnisse der Schmerz- und Verhaltenswissenschaften als auch die bewusste und zielgerichtete Anwendung bestimmter interaktiver Strategien (Soft skills) können dazu beitragen, dass sich HCP für den Umgang mit diesen Patienten ausreichend gewappnet fühlen.
Das transtheoretische Modell der Verhaltensänderung definiert Verhaltensänderung als einen zeitlichen Prozess, der verschiedene Stadien durchläuft. Mithilfe des Clinical Reasoning sollten sowohl Inhalt als auch Timing der Patientenaufklärung im Verlauf dieses Prozesses ermittelt werden. Da laut dem Modell Verhaltensänderungen zuerst kognitiv beginnen und sich erst später im Prozess auch im aktiven Verhalten manifestieren, sind verschiedene therapeutische Maßnahmen zu unterschiedlichen Zeiten sinnvoll.
Abstract
Due to their presented clinical symptoms, personality and on health care practitioners (HCP) imposed stress some patients in clinical practice can be justifiably regarded as ”problematic”. Very often there does not seem to be any detectable biomedical explanation for their pain or functional limitations. Consideration of current pain and behavioural sciences research as well as consciously and purposeful applying certain interactive strategies (soft skills) can assist HCP in feeling appropriately armed to deal with these patients.
The transtheoretical model defines behaviour change as a temporal process passing different stages. During this process content as well as timing of patient education should be determined by means of clinical reasoning. Since according to the model behavioural changes begin cognitively and manifest themselves later in this process in active behaviour variable therapeutic modalities are reasonable in different stages.
Schlüsselwörter
problematischer Patient - transtheoretisches Modell der Verhaltensänderung - Placebo - Nocebo - Schmerzüberzeugungen - Angst-Vermeidungs-Verhalten - Selbstwirksamkeit
Key words
problem patient - transtheoretical model of behaviour change - placebo - nocebo - pain beliefs - fear avoidance behaviour - self-effectiveness
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