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Many types of cancer are thought to be caused, at least in part, by a whole host of unhealthy lifestyle behaviours – smoking, alcohol, poor diet, too little physical activity or too much stress. Common sense would tell you that on being diagnosed with cancer, or on recovery from treatment a key priority ought to be in cleaning up one’s act i.e. addressing relevant lifestyle factors; adopting new habits and kicking old ones to the kerb. But is changing a behaviour as straightforward as it sounds?
Unhealthy behaviours can be long-standing, deep-rooted and intertwined with feelings and emotions making them harder to just leave behind. They require quite a bit of unpicking, a deep level of understanding of the individual – how they ‘tick’, how they are likely to respond to being asked to change and how the change would fit into their lives. Health coaching is an effective way of facilitating individual change.
Public Health England defines health coaching as: ‘a patient-centred process that is based upon behaviour change theory and is delivered by health professionals with diverse backgrounds’. Professionals equipped with skills in health coaching can play an important role in empowering people to change behaviours and equipping them with strategies to sustain those changes for life.
The term has been cited in numerous research journals with one paper going on to say it is about ‘advancing healthy lifestyle behaviour change using tools such as non-judgmental dialogue, goal setting, and accountability’.
Health coaching is not, therefore, about dictatorship – telling someone to do something – “Eat more vegetables!”, “exercise daily!”, “quit smoking!”, “Cut down on alcohol!” and off you go. (Let’s face it, very few of us in this world respond well to the ‘being told what to do’ approach.) It is more about releasing a person’s potential to maximise their own health.
People don’t just make dietary changes overnight off the back of a suggestion that meat consumption reduction could increase longevity for example. Most of us want to ‘live a little!’ Even where someone is extremely motivated and makes that executive decision (perhaps on a Sunday night after an indulgent weekend) to start a new diet or hit the gym, we all know the biggest challenge is in sustaining that change. Where will that person be three months down the line?
Health coaching is about providing new ways of engaging people and facilitating shared decision-making. In the clinical context “performance” equals self-management.
Five criteria have been set out in the literature as important aspects of health coaching:
Many people believe that coaching is about building a rapport with clients and communicating effectively with them. True health coaching however goes above and beyond this. It requires expert practitioners to step back from their usual role as educators and instead focus on becoming an ally to clients, potentially a difficult task for the ‘walking encyclopaedia’ types. It is about moving the conversations from ‘what is the matter with you’ to ‘what matters to you’. Effective health coaching requires high quality training. One researcher advocates it should be conducted using behavioural interventions and models such as adult learning theory, social learning theory, motivational interviewing, and the stages of change model.
Emerging evidence is demonstrating a role for health coaching in cancer care, in improving patient outcomes, medical compliance and reducing health care costs. Some studies have found improvements to measures of health, fitness and in particular psychological outcomes in cancer patients e.g. psychosocial outcomes, general mental health and quality of life. With high levels of anxiety and other adverse psychological effects associated with the disease and its treatment, and with Cancer Research UK now predicting that one in two of us will develop cancer at some point in our lives, it is crucial that we perceive measures like coaching, to be a vital part of effective healthcare.
We now know that increasing physical activity can improve survival in people with cancer, that diet, smoking and alcohol are linked to an increased cancer risk, and that better lifestyle behaviours can actually mean a better quality of life for people. Thus, implementing a health coaching programme that can effectively change behaviours in people with cancer for the better would not just improve quality of life for people but also quantity of life i.e. an extended survival period.
Given that most people diagnosed with cancer struggle with an initial loss of control, it seems obvious that interventions like health coaching, that are integrated into prehabilitation, rehabilitation, or in fact any phase of a person’s cancer journey, are instrumental in helping people to take back control and take charge of their health and outcomes.
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