Brief Action Planning to Facilitate Behavior Change and Support Patient Self-Management

Another caveat to consider is that the process of planning is more important that the actual plan itself. It is imperative to allow the patient, not the clinician, to determine the plan. For example, a patient with multiple poorly controlled chronic illnesses including depression may decide to focus his action plan around cleaning out his car rather than disease control such as dietary modification, medication adherence or exercise. The clinician may initially fail to view this as a good use of clinician time or healthcare resources since it seems unrelated to health. However, successful completion of an action plan is not the only objective of action planning. Building self-efficacy, which may lead to additional action planning around health, is more important [4,46]. The challenge is therefore for the clinician to take a step back, relinquish the “expert role,” and support the goal setting process regardless of the plan. In this example, successfully cleaning out his car may increase the patient’s self-efficacy to control other aspects of his life including diet and the focus of future plans may shift [4].

When to Use BAP

Opportunities for patient engagement in action planning occur when addressing chronic illness concerns as well as during discussions about health maintenance and preventive care. BAP can be considered as part of any routine clinical agenda unless patient preferences or clinical acuity preclude it. As with most clinical encounters, the flow is often negotiated at the beginning of the visit. BAP can be accomplished at any time that works best for the flow and substance of the visit, but a few patterns have emerged based on our experience.

BAP fits naturally into the part of the visit when the care plan is being discussed. The term “care plan” is commonly used to describe all of the care that will be provided until the next visit. Care plans can include additional recommendations for testing or screening, therapeutic adjustments and or referrals for additional expertise. Ideally the patients “agreed upon” contribution to their care should also be captured and documented in their care plan. This is often described as the patients “self-management goal.” For patients who are ready to make a specific plan to change behavior, BAP is an efficient way to support patients to craft an action plan that can then be incorporated into the overall care plan.

Another variation of when to use BAP is the situation when the patient has had a prior action plan and is being seen for a recheck visit. Discussing the action plan early in the visit agenda focuses attention on the work patients have put into following their plan. Descriptions of success lead readily to action plans for the future. Time spent discussing failures or partial success is valuable to problem solve as well as to affirm continued efforts to self-manage.

BAP can also be used between scheduled visits. The check-in portion of BAP is particularly amenable to follow-up by phone or by another supporter. A pre-arranged follow-up 1 to 2 weeks after creation of a new action plan [8] provides encouragement to patients working on their plan and also helps identify those who need more support.