L3: Dr/Pt Relationship III

Question 1

What are the basic elements/principles of motivational interviewing?

Answer 1

• Express empathy (not sympathy) - Develop discrepancy (enables pt to see where they are and where they want to be) - Avoid argumentation (collaborate) - Roll with resistance (invite new perspectives, pt must find answers and solutions, pts objection or minimization does not require response) - Support self-efficacy (pt must believe in possibility of change)

Question 2

Define engagement.

Answer 2

• process by which doctor and patient initiate and maintain an effective working relationship

Question 3

What are ways to facilitate pt engagement?

Answer 3

• Use open-ended questions - Use evocative questions, which elicit self-motivation statements from pt (eg. If you were to change, what would be the best results you can imagine?) - Reflectively listening (repeating, rephrasing, empathic, reframing, double-sided reflection (both sides of ambivalence explored))

Question 4

What are attitudes that contribute to resistance during an interview?

Answer 4

• Arguing for change - Assuming expert role - Criticizing, shaming or blaming - Labeling - Being in a hurry - Claiming preeminence (ie. superiority)

Question 5

Identify factors that are likely to influence pt success with change.

Answer 5

• Affirmation (eg. It says a lot that you took the step in coming here today.) - Intention & Commitment (eg. How much do you want to do this?) - Elicit “change talk” (eg. What worries you about your current situation? What would be the good things about losing weight?) - Express optimism (eg. What personal strengths can you use to help you succeed?) - Summarize (link statements together and reinforce material discussed)

Question 6

What are common errors in the interview that lead to disengagement?

Answer 6

• Inadvertently shaming, embarrassing or humiliating pt - Finding fault with or blaming the pt - A focus on assessment to the exclusion of relationship - Drawing premature conclusions - Assuming a common understanding - Spending too much time in social chit-chat

Question 7

What is motivational interviewing?

Answer 7

• It is a method to engage pts as collaborators in health behavior changes and facilitate pt motivation for change. Does not provide pts with solutions or problem-solving until they make a decision to change. Relies upon shared decision-making.

Question 8

What are the core interviewing skills used during motivational interviews?

Answer 8

• Open-ended questions (followed by reflection) - Affirming by other and self (acknowledge positive) - Reframing (in positive light) - Summarizing