Communication as a Dance: What Palliative Care Providers Can Learn from Motivational Interviewing (426)

Abstract

1.Recognize how the spirit of motivational interviewing (empathy, evoking values and motivations, and respecting autonomy) parallels the communication style of palliative care.2.Use motivational interviewing skills to help patients and families work through ambivalence.3.Use reflections as a way to express empathy and help patients and families tell their stories. Palliative care clinicians often are called upon to help patients and families make decisions. Most times, clinicians ask questions to learn more about patient values. However, this may lead to the provider dominating the conversation, asking question after question. Even open-ended questions reflect the provider's agenda and may throw up a roadblock against the patient telling her own story. In this session, we introduce a set of techniques derived from motivational interviewing (MI). The philosophy of MI involves exploring ambivalence non-judgmentally and supporting patient autonomy and self-efficacy while individuals find their own solutions. The skillful use of MI often makes motivational interviewing sessions look more like a dance than a typical patient interview. These strategies may prove useful to palliative care clinicians who are helping patients or families explore their values and make difficult clinical decisions. To create the dance, MI providers use four strategies: open-ended questions, affirmations, reflections, and summaries. This session will focus on the skill least taught to clinicians—turning questions into reflections. In MI, reflections are statements that mirror back what the speaker has expressed (simple reflection) and may also present a hypothesis about the speaker's deeper meaning or feelings (complex reflection). Skillful reflections show that clinicians hear what patients have said and create a unique atmosphere of empathic communication that often allows less verbal individuals to express their feelings. Participants will be introduced to the MI approach and how it can be used non-directively to help patients and families work through ambivalence about end of life decision-making. Through video examples and role-play, participants will see the contrast between a question-centered patient interview and a more-naturally flowing reflection-centered one. The session will also include interactive group exercises to develop reflective listening. Participants will leave the session with a new skill in their communication toolbox.