Table 1

Tops tips for discussion between the healthcare professional and the patient about treatment burden

For the patientFor the healthcare professionals
Prepare questions and practice explaining about concerns before your consultationPatients with chronic conditions have to adjust to the implications of the diagnosis on their life and lifestyle. Be sensitive with how you communicate this
Take a carer or friend with you to consultations. Brief them about your questions and concerns and ask them to help listen to the information providedEncourage the patient to bring a companion; and encourage them to write down key information
Think about treatment goals and be clear what is important to you (e.g. being less breathless, being able to run)Discuss lifestyle behaviours of the patient: what are their priorities? This will help to guide the best medication, taking into account issues such as side-effects, monitoring requirements, cost, impact on driving and family
Ask for the names of other HCPs (e.g. specialist nurse) who you can discuss this with in more detail in the futureProvide details, where possible, for a nurse or pharmacist who will have the time to have a longer/further discussion with the patient; but ensure the messages are consistent
Ensure that you understand why a treatment is being recommended and ask for further information to help you make decisions about this if requiredExplain clearly what treatments are available so patients can make an informed choice. Remember that limited health literacy is common even without specific challenges or learning disabilities
Read and learn from trusted/reputable resources. Ask about good sources of informationProvide the patient with details of a trusted patient organisation or peer-support group from which they can gain input and further advice
Ask about side-effects, and about how likely they are to happen. Check what you should do if you are experiencing a side-effectDo not wait to be asked about side-effects. Tell patients about anything common or potentially serious and ensure they know what to do if a problem develops
Explain any factors that you feel may make it harder for you to take your medicines or follow the treatment recommendations givenExplore non-adherence in a non-judgemental way to agree with the patient how to gain benefit from treatment, personalised to the individual's circumstances
Ask if you think that one of your medications is no longer needed or is causing side-effectsAgree with the patient if specific medications can be stopped or regime modified (using tools such as STOPP/START). Regularly review treatments to de-prescribe, if appropriate
Ask about written information (such as action plans) that could help you follow adviceProvide simple, written follow-up advice, including self-management plans (e.g. asthma action plans [8]), which can empower patients to be partners in their care
Medication reviews are important for safe use of medications – use them to discuss any concerns that you have about your treatmentUsing a qualitative measure of treatment burden at annual reviews could offer an opportunity to raise issues that are bothering the patient [9]