Lecture_4_Case Application--Motivational Interview & the Transtheoretical Model (Susie Jones Interview)

Question 1

Describe key elements of a patient interview focusing on behavioral change:

Patient Interview Outline:

• what are the main components of the patient interview?
  
  • examples of each

Answer 1

• What are the main components of the patient interview?
  
  • Engage the pt & build rapport in an empathetic manner (attuned to the nature & setting of the encounter)
  • Inquire about the context of the encounter
    
    • “How did you decide to make an appointment to see me today?” (if new pt.)
  • Ask about the presenting problem/concern
    
    • “What brought you in to see me today?”
    • “What brought you to the office/ER/etc. today?”
  • Seek permission and set an agenda for a motivational interview
    
    • “This is obviously an area of importance to you. Could we talk about this in more detail?”
  • Explore the history of the problem/concern
    
    • “How long have you been concerned about this?”
    • “When did it start?”
    • “How has it changed since you first became concerned about it?”
  • Ask about a precipitating event (“Trip Point”)
    
    • “What happened that alerted you to the need to do something about this now?”
  • Explore attitudes, beliefs, resistances (barriers to change), and ambivalence
    
    • “What are some of the attitudes and beliefs you have about this that affect the way you think about it?”
    • “Describe for me some of the reasons you may not have been concerned about this before now?”
    • “What obstacles do you see that might hinder you in addressing this concern?”
  • Explore pt’s strengths & resources–Identify and affirm areas of self-efficacy
    
    • “How have you dealt with serious concerns before in your life?”
    • “If you should decide to deal with this matter, what are some personal resources you have that could be of help to you?”
    • “What community resources are you aware of that could be of help to you with this?”
  • Develop discrepancy & assess motivation to change–assess intrinsic motivation to change
    
    • “What beliefs might there be for you wanting to keep things the way they are?”
    • “What are some of the positives and negatives you see in addressing this concern?”
    • “How might this situation put you at risk in some way?”
    • “How might you feel if you found a way to solve this problem?”
  • Recognize & assess risk factors (evaluate the safety and welfare of the pt. & others)
    
    • “Are you concerned about your safety or the safety of others in any way? (Are there any weapons at home? Is anyone involved impulsive?)”
    • What thoughts have you had about how you might protect yourself, or where you might go, if you need help in an emergency?”
  • Summarize; negotiate a plan for change &/or follow-up; offer recommendations, resources and/or referrals as appropriate to the situation
    
    • “As we have talked today, you have identified some factors that have contributed to the concern(s) you have and how you tend to think about your situation. Any change is definitely difficult.
    • “Would you like to meet again to furthe rdiscuss this concern and perhaps develop a plan to address it?”
    • “Would you like me to give you the names of people and places that could be helpful with this type of situation?”
  • End the interview (attuned to the nature and setting of the encounter, and how it transpired)
    
    • End in in a respectful manner that is not rushed and that conveys concern and hope, while remaining attuned to the person’s affective state.

Question 2

Describe key elements of a patient interview focusing on behavioral change:

Patient Interview Outline for SPAL:

• What is the suggested interview outline for SPAL?

Answer 2

• Facilitate engagement with the pt–monitor affect
• Demonstrate empathy
• Explore context for encounter
• Explore presenting problem/concern
• Seek permission to talk more in depth about this problem/concern
• Explore history of the problem
• Ask about precipitating event(s)
• Explore ambivalence, attitudes, beliefs and resistances to change
• Explore patient’s strengths and resources; affirm self-efficacy
• Develop discrepancy
• Assess intrinsic motivation and readiness to change using the Transtheoretical Model (stages of change)
• Evaluate safety and welfare of the pt and others
• Summarize
• Negotiate a plan for change and/or follow-up
• Offer recommendations and/or referrals as deemed appropriate
• End the interview