breaking bad news and motivational interviewing

Question 1

setting up the interview

Answer 1

privacy, involve significant others
sit down, allow the patient to dress before giving results
manage time constraints

Question 2

perceptions

Answer 2

use open ended questions to get an idea of how the patient percieves the medical situation

Question 3

invitation

Answer 3

‘how would you like me to give you the test results’

Question 4

knowledge

Answer 4

give information in small chunks and check periodically as to the patients understanding

Question 5

emotions

Answer 5

observe emotions, acknowldge them, identify the reasonn for them, ask the patient how thy are feeling

Question 6

strategy and summary

Answer 6

give the patient a clear plan
discuss prognosis

Question 7

smokers who are ready to quit should be assisted by

Answer 7

agreeing on a quit date
identifying smoking triggers and discussing quit strategies
providing self-help materials
prescribing pharmacotherapy based on clinical suitability and patient preference
arranging follow-up visits every 1-2 weeks to prevent relapse
considering referral to a quit program

Question 8

varenicline

Answer 8

the most effective monotherapy
nausea occurs in some people but this can be minimised by taking the tablet with food

Question 9

options for oral NRT

Answer 9

varenicline
bupropion

Question 10

things you can arrange for smokers

Answer 10

refer to quit program eg. quitline who may send patients a quitbook

Question 11

when to consider inpatient or residental assisted withdrawal of alcohol

Answer 11

• drinks >30 units per day
• score of >30 on SADQ
• Hx of epilepsy or withdrawal related seizures or delirium tremens during previous withdrawals
• needs concurrent withdrawal from alcohol and benzodiazepines
• psychiatric or physical comorbidity

Question 12

methods of promoting alcohol abstinence

Answer 12

consider acamprosate or oral naltrexone in combination with individual psychological therapy eg. CBT, behavioural therapies or social network and environment-based therapies that focusses specifically on alcohol misuse

Question 13

SADQ

Answer 13

severity of alcohol dependance questionnire
self administered 20 item questionaire designed by WHO to measure seveerity of dependance on alcohol

Question 14

oral drug options for promoting alcohol abstinence

Answer 14

naltrexone or acamprosate