Learning From Other Patients

March 22, 2012,
Learning From Other Patients
By PAULINE W. CHEN, M.D., Columnist

Sometimes, patients can be one of the best sources of information.Thinstock/Getty ImagesSometimes, patients can be one of the best sources of information.

Several years ago, I was invited to give a lecture to a group of patients who had received organ transplants at the hospital where I was working. The evening started well — patients I had cared for greeted me warmly, and everyone seemed interested in the talk I had prepared. But as soon as I was finished, the audience started asking questions, and I began to feel a creeping sense of doubt about my performance.

While I was able to reel off statistics on the latest treatments and medications, I found I had little to offer when it came to issues most pressing to them. I wasn’t sure of the best way to organize and remember the dozens of medications they were required to take. I didn’t know the most efficient way for them to schedule follow-up visits with me or my colleagues. I had no suggestions other than more pills for dealing with the nausea induced by their anti-rejection drugs. And I could only listen, speechless, to stories about co-workers who continued to discriminate against them by treating them like “sick people.”

I watched as the audience spontaneously broke out into smaller groups, people’s faces lighting up as they recognized their own travails in the stories of others.

The event organizer, a transplant patient herself who regularly coordinated lectures like this, approached me. To my surprise, instead of being upset with me, she bubbled over with praise.

“What you’ve done tonight is to help each of these people begin talking with someone who has been through the exact same experience,” she said. She looked out at the audience and smiled. “This,” she said, pointing to the clusters of conversations, “means more than you realize.”

I remembered her words when I read a study published this week in Annals of Internal Medicine on the effects of peer mentoring.

Researchers analyzed the blood glucose control of 120 African-American patients struggling with diabetes. The researchers chose these patients because African-Americans tend to be affected more frequently and have more severe complications than other groups from diabetes, a condition that can be mitigated by changes in diet and exercise.

The patients were randomly divided into three groups. Those in one group saw their doctors and received the usual care; those in another group were offered up to $200 if they could improve their glucose control over time; and individuals in the third group were assigned a peer mentor, a fellow patient who had also struggled with but eventually managed to control his diabetes.

Peer mentors were encouraged, but not required, to phone their assigned mentee once a week.

After six months, the only group of patients who had significantly improved their blood sugar control was the group with peer mentors. Those who were promised a financial reward showed only slight improvements, and those who simply saw their doctors regularly did not improve at all.

“People who were struggling with their diabetes managed to create a partnership with those who had faced the same issues but managed to do well,” said Dr. Judith A. Long, lead author and a staff physician and faculty member at the Philadelphia Veterans Affairs Center for Health Equity Research and Promotion.

While work done by the mentors in this study seems similar to that performed by community health workers, carrying out this peer mentor program was far less complex and time-consuming. During an hourlong one-on-one training session with a research assistant, the mentors learned some motivational techniques, like asking open-ended questions and identifying realistic goals. But mostly, they were encouraged to draw on their own history.

“We told them that we chose them because they are the experts,” Dr. Long said. While the researchers offered some potential phrases to use, “we wanted their advice to come very much from their own experiences.”

Not all of the study patients looked forward to being mentored. Some even became upset when assigned to the peer mentoring group. But eventually many of the pairs developed strong ties, and several stayed in contact after the study was completed. One patient who was initially unhappy about being paired became such good friends with his mentor that the two continue to meet regularly for lunch at the hospital canteen.

Despite the improved blood sugar control among the mentored patients, the researchers acknowledge that it is still unclear how long the positive effects of these relationships will last and whether the patients can maintain their new habits in the long term. To help answer these questions, the researchers have developed a larger and more extensive peer mentoring study. They hope to look also at the effect of mentoring on the health of the mentors, as well as ways to tap into the growing number of “successfully mentored” individuals who want to mentor others.

“There’s that ‘pay it forward’ feeling,” Dr. Long said. “People’s good will comes through, and because they were mentored, they want to mentor someone else.”

That good will, and the real-life expertise that comes with it, give Dr. Long and her colleagues much hope for the future of programs like this one. “A lot of the management of chronic diseases happens outside of the doctor-patient interaction,” Dr. Long said. “And over the course of a year even with their sickest patients, primary care doctors spend maybe three hours total with them.

“But peer mentoring is an inexpensive, easy and patient-centered way we doctors can support healthy behaviors outside of our offices.”

Fuente: Diario The New York times, USA
http://well.blogs.nytimes.com/2012/03/22/learning-from-other-patients/?ref=health