Helping the “Unreasonable” Patient: Adding Motivational Interviewing Techniques to Your Communication Toolkit (P20)

Abstract

1.Describe the application of the motivational interviewing spirit and techniques to palliative care.2.Demonstrate the use of open-ended questions, affirmations, reflections, and summaries to build rapport and help patients and families who are having difficulty discussing decisions.3.Demonstrate the use of open-ended questions and reflections to guide family meetings and recommend appropriate goals of care. Palliative care clinicians are often asked to see the most “difficult” patients and families. These may be individuals who disagree with the medical team's recommendations, those who ask for “unreasonable” interventions, or those who are stuck and unable to make a decision about goals of care. Motivational interviewing (MI), originally developed for communicating about substance abuse, is an approach with specific strategies that can help in these challenging conversations. Central to this approach is that the practitioner enters difficult conversations with curiosity and the desire to understand. MI practitioners reduce resistance by avoiding arguing and instead explore goals and values with reflective listening. It then becomes possible to guide patients and families through difficult decisions, using the MI skills of empathic listening and evocation to help individuals find their own solutions. The techniques used in MI are also commonly used by palliative care practitioners: open-ended questions, affirmations, reflections, and summaries. The techniques, however, can be applied more effectively than palliative care practitioners commonly do, namely to guide a conversation to help resolve ambivalence or resistance. In 2012, we presented a well-attended concurrent session at the Annual Assembly that was an introduction to MI and focused on developing reflective listening ability. Many participants requested more in-depth training. This workshop will re-introduce those basic MI skills and allow participants to practice so they can see how the use of reflections and open-ended questions, along with the MI spirit, can help build rapport, explore patient and family ambivalence, identify important values, and focus discussions on developing goals of care that are consistent with these values. More than half of the session will consist of small group exercises to practice MI techniques.