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ME 528- Patient Communication > Motivational Interviewing > Flashcards

Motivational Interviewing Flashcards

1
Q

Motivational interviewing definition

A

Patient centered counseling style for eliciting behavior change in order to improve a patient’s health

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2
Q

What is the most effective way to motivate people to change?

A

Motivational interviewing

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3
Q

Eliciting or drawing out reasons for ______ from change is more effective than trying to convince them to change

A

change

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4
Q

Key elements to motivational interviewing

A

developing rapport and collaborative alliance

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5
Q

_______ for the patient

A

compassion

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6
Q

How can we show compassion

A

Non-judgmental, tolerating their distress, expressing your desire to help

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7
Q

Acceptance and respect for the _____________ ____________

A

Patient’s autonomy

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8
Q

What question can we ask to show we support patient autonomy during motivational interviewing

A

what steps are you ready to take at this time?

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9
Q

Three pieces to motivational interviewing approach?

A
  1. compassion for the patient
  2. Acceptance and respect for patient autonomy
  3. Collaborative partnership with the patient
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10
Q

Key component of empathy

A

listening

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11
Q

What should you avoid in motivational interviewing?

A

Avoid labeling the behavior as a problem

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12
Q

What questions can you ask to help understand the patient’s perspective?

A

What do you see as your challenge making this change?

What do you look forward to the most in overcoming this concern?

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13
Q

DARN CAT

A

Desire to change
Ability co change
Reasons to change
Need to change

Commitment to change
Action, intention to act
Taking the steps to change

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14
Q

DARN out of DARN CAT is what port of change

A

preparing for change

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15
Q

CAT out of DARN CAT is what part of change

A

mobilizing for change

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16
Q

“I could cut back a little”

A

Need to change

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17
Q

“I have to quit for my children”

A

Reasons to change

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18
Q

“I’m going to do it. I’m going to change”

A

Action, intention to act

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19
Q

I want my life back

A

Commitment to change

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20
Q

Motivational interviewing approach: directive

A

don’t tell the patient what to do and avoid giving advice, guide towards being introspective

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21
Q

Motivational interviewing approach: non-directive

A

patient produces their own motivations, goals and ambivalence. Develop a plan collaboratively.

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22
Q

Non-directive motivational interviewing approach is _______

A

patient centered

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23
Q

Directive and non-directive combined

A

guide them to act on motivations, participate in collaboration

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24
Q

Authoritative

A

unsolicited, direct advice
The provider is the expert

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25
Q

Patient centered

A

The patient is involved for their motivations and behaviors, even if they need help uncovering

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26
Q

What would you like to see in your life a year from now, regarding your drug use?

A

Patient centered

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27
Q

Research shows that people do better at quitting smoking when they use a smoking cessation medication

A

Authoritative

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28
Q

We are going to get you on a plan that I think will work for you

A

authoritative

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29
Q

what do you think contributed to your relapse

A

patient centered

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30
Q

OARS

A

Open ended questions
Affirmations
Reflective listening
Summaries

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31
Q

Ask, tell, ask approach is also the _______

A

OARS

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32
Q

What are open ended questions important?

A

Build momentum vs. closed ended which can be conversation stoppers

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33
Q

What is the intent of purposeful pauses?

A

Pausing can work like a question after a reflective statement, pause: many patients will fill the pause

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34
Q

What are affirmations important?

A

Recognize, highlight and respond to a patient’s strengths and healthy behavior in a positive light. Develops patient’s feeling of hope and confidence, acknowledge strength

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35
Q

What are some examples of affirmations?

A

I am encouraged to hear that you have thought about quitting

What changes have you been successful in making in your life?

You have courage to seek treatment at this time

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36
Q

Why is reflective listening important?

A

listen and reply with summarized version of what they said, demonstrates that you understand the patient’s view and are non-judgemental

37
Q

Reflections are not _______- they are ______ that mirror the content or emotional tone of the patient’s own words

A

questions, statements

38
Q

Reflective listening ex:
I drank though my divorce, losing my job….

A

It sounds like you drank during some pretty hard times

39
Q

Reflective listening ex:
I want to live to se my granddaughter graduate high school, college, get married and have a child

A

Being there for your granddaughter is important for you

40
Q

It would be more than I can take to try and get sober and fail again

  1. I don’t see you as a failure
  2. Do you worry about failing
  3. From your perspective, failing again would be very distressing
  4. It would be more than you can take to fail again
A
  1. From your perspective, failing again would be very distressing
41
Q

Provide attention to ______ _______ and less to “non-change” or “sustain” talk

A

change talk

42
Q

Example of change talk

A

I am interested in hearing more about how you want to start treatment

43
Q

Example of reflecting emotion

A

It looks like you feel sad about that

44
Q

Reflective listening tips

A
  1. Provide attention to change talk
  2. Occasionally reflect emotions, especially non-verbal
  3. Offer more reflections than questions
  4. Sometimes, you can exaggerate what they say
45
Q

Summarizing

A

Summarizing key points during the discussion helps reinforce them

46
Q

“So far, you’ve listed three reasons to keep smoking, and three reasons to quit. And you said quitting for daughter’s sake was the most important of all these reasons”

A

Example of summarizing

47
Q

Engaging

A

Gain trust and invite patient to collaborate on making a change

48
Q

Focusing

A

helping patient focus on a specific aspect of the health problem

49
Q

Evoking

A

using questions to guide patient about stating their feelings and thoughts and their motivation to change

50
Q

Planning

A

facilitating the patient in establishing a plan for achieving their goal

51
Q

Engaging helps to support the ________ alliance with the patient

A

therapeutic

52
Q

How should you introduce a topic of health concern

A

openness, concern and lack of judgement

53
Q

Establishing rapport increases the patients ______ to change and building a therapeutic alliance

A

openness

54
Q

Steps in establishing rapport

A
  1. ask permission
  2. be reassuring
  3. normalize- left them know they are not alone
55
Q

There were signs of drug use in your physical today. Can we talk about that?

A

Example of asking permission

56
Q

I hope we can just talk and explore what’s going on, to see if I can be of any help

A

Example of being reassuring

57
Q

Other people have bottomed out too and have recovered. You are not alone

A

Example of normalizing- let them know they are not alone

58
Q

Mrs.Adams is a 28yo female presenting for her annual CPE and you notice her BMI is not in the obese range.

  1. I am sure that you have had some bad experiences due to your obesity. Let’s work together to help you lose weight.
  2. Do you feel comfortable discussing your weight as it relates to your health?
  3. How can I help you lose weight?
  4. I think we need to set a plan for you to lose weight
A
  1. Do you feel comfortable discussing your weight as it relates to your health?
59
Q

To achieve a focus you may need to:

A

suggest a menu of options, negotiate the focus, narrow the focus as needed, ensure focus is clear and strong enough to support change

60
Q

Focusing

A

Collaboratively selecting a target behavior based on the patient’s concerns

61
Q

You may need to re-focus at ______ office visit

A

each

62
Q

“because you are just starting to consider to stop smoking, we could clarify what you might get out of quitting, what might get in the way, or what you will need to succeed? What would you like to focus on?”

A

Example of focusing a patient

63
Q

Basic steps for evoking

A

invite the patient to state their insights and ideas rather than imposing provider’s own ideas

64
Q

Motivation to change
Readiness for change
Feelings of ambivalence

A

Evoking statements

65
Q

Motivation to change

A

individual’s sense of importance in changing, confidence in being able to change, willingness to change

66
Q

How is it for you living with this?

So, what do you think about what we’ve discussed so far?

A

Evoking questions

67
Q

Ambivalence

A

wanting both pleasure of indulgence and benefits of restraint

68
Q

What is a principal obstacle in ambivalence

A

lack of resolve

69
Q

Strategies for ambivalence

A

Articulation, decisional balance, resolution & change guide

70
Q

Articulation

A

get patient to explain and clarify why they are not concerned

71
Q

Decisional balance

A

examining the pluses and minuses to help clarify

72
Q

Resolution & change-guide

A

more likely to produce change

73
Q

When asked about quitting drinking on a scale of 1-10, Mrs.Adams says “Oh, I’d say about a 3”

  1. with my help that will soon be a 10
  2. Why not higher?
  3. Why not lower?
  4. That’s sad, truly sad
A
  1. Why not higher?
74
Q

In motivational interviewing the _______ should produce their own _____ ______ _____

A

patient, plan for change

75
Q

“Tell me what you would like to accomplish regarding quitting smoking in the next 90 days”

A

example of planning

76
Q

Avoid building ______ in the first place

A

resistance

77
Q

What can you do to help with resistance?

A
  1. avoid building it in the first place
  2. De-escalate
  3. Work their resistance
78
Q

Resistance is considered a product of the interaction between the provider and the patient, rather than a _____ of the patient

A

trait

79
Q

Why does resistance occur?

A

Stems from the provider assuming patient is more ready than they really are

80
Q

Strategies to help with resistance

A

invite patient to consider a different perspective
monitor their readiness for change
affirm the patient that they have freedom of choice and self direction

81
Q

How to de-escalate resistance

A
  1. refocus on building rapport with the patient
  2. Ask if they would be willing to review a past, successful health behavior or change
  3. Ask about a less threatening health behavior like getting enough sleep or increasing daily walking
  4. Be prepared to discuss at a later visit
82
Q

The only way to have sustained change over a long period of time is by being an

A

advocate

83
Q

How to work resistance

A
  1. Do not confront it
  2. Agree with the patient
  3. Reframing- glass half empty vs. glass half full
84
Q

Mr.Arnolds, a musician, tells you “If I quit doing drugs, I won’t be able to perform anymore”

  1. That could be true. You might find that the only reason you can play the guitar well is because you use drugs
  2. You’re worried you won’t be able to play guitar well without drugs
  3. That’s a pretty ridiculous attitude, isn’t it?
  4. How did you play before drugs?
A
  1. That could be true. You might find that the only reason you can play the guitar well is because you use drugs
85
Q

Motivational interviewing in the office has

A

time constraints

86
Q

When is motivational interviewing the most effective?

A

after the initial screening (SBIRT)

87
Q

How should motivational interviewing be use?

A

briefly and repeatedly

88
Q

What are basic steps for motivational interviewing

A

Engaging, focusing, evoking, planning

89
Q

What is Winnie’s favorite question

A

“Help me to understand”

ME 528- Patient Communication (5 decks)

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