POLINA SAYESS, MD CHANGE TALK: MOTIVATIONAL INTERVIEWING IN URGENT CARE AND BEYOND

Transcription

1 POLINA SAYESS, MD CHANGE TALK: MOTIVATIONAL INTERVIEWING IN URGENT CARE AND BEYOND NHAFP CME Mountain View Grand Resort April 8, 2017

2 What you should get out of this presentation 1. You will know the advantages of using the Motivational Interviewing (MI) to elicit positive behavior changes. 2. You will use practical interactive examples to learn or improve MI skills. 3. You will be able to identify specific MI techniques you can apply in a clinical setting even when time is limited, e.g., an urgent care setting.

3 POLINA SAYESS, MD Board- certified Family Medicine Physician Full time provider at the Barrington Walk-In Care, a division of Frisbie Memorial Hospital

4 POLINA SAYESS, MD NH delegate to AAFP Congress of Delegates 2016 & 2017 New Hampshire Medical Society Council 2015-present Disclosures: none.

5 McGill University

6 We were never designed for the sedentary, indoor, sleepdeprived, socially-isolated, fastfood-laden, frenetic pace of modern life. Stephen Ilardi, PhD

7 Stephen S. Ilardi, PhD, is an associate professor of clinical psychology at the University of Kansas and principal investigator of Therapeutic Lifestyle Change (TLC)

8 Lifestyle Determines ~50% of health

9 Are we engaging the patients?

10

11 DEFENSIVENESS RESISTANCE DIRECTIVE APPROACH STOP LISTENING ARGUMENT WASTE OF TIME FRUSTRATION NOT APPRECIATED

12 MOTIVATIONAL INTERVIEWING Patient-centered Change Talk explores ambivalence Elicits inner motivations

13 MOTIVATIONAL INTERVIEWING Empowering Engaging Respectful Collaborative

14 MOTIVATIONAL INTERVIEWING IN URGENT CARE

15 Have you ever considered quitting smoking? YES and NO Please tell me about YES I tried quitting but restarted OPEN-ENDED QUESTIONS

16 OPEN ENDED QUESTIONS Encourage to open up and tell their story Cannot be answered in one word Not biased, leading or judgmental

17 OPEN ENDED QUESTIONS Why do you think Tell me about What do you think about?

18 OPEN ENDED QUESTIONS Allow to explore ambivalence Invite to consider the benefits of change

19 OPEN ENDED QUESTIONS If you were to make a change, what would the benefits be? What are the three best reasons for you to do this?

20 How did you try quitting in the past? Nicotine patch and cold turkey How was your experience? I liked the patch, quit for a few months, then restarted. OPEN-ENDED QUESTIONS

21 Tell me why did you try quitting smoking? I would like to be around for my grandchildren ELICITING INNER MOTIVATION

22 Please tell me more about your grandchildren My granddaughters are 3 and 5 years old I would like to see them graduate from college It sounds like you have good reasons to stay healthy REFLECTIVE LISTENING

23 REFLECTIVE LISTENING Rephrasing what the patient/ family said Clarify the meaning of what the family told Simple paraphrases of the informations or emotions

24 REFLECTIVE LISTENING So It sounds like What I am hearing is

25 May I share something with you? Sure, thank you It usually takes 7 tries before the patients are successful in their attempts to quit smoking. I did not know that ELICIT-PROVIDE-ELICIT

26 What do you think about trying to gradually cut down on the number of cigarettes? I am not so sure about that You mentioned that you were successful quitting using a patch in the past Yes, I liked the patch and would like to try it again AFFIRMATIONS

27 AFFIRMATIONS Calling attention to genuine strengths Simple observation, without judgement, opinion, or even personal approval

28 Ok, it sounds like you wish to quit smoking to stay around for your grandchildren and you would like to try a nicotine patch again. When would you like to start that? Indeed. I think I will call my doctor as soon as I leave from here. SUMMARIZING AND CLOSURE

29 SUMMARIZING AND CLOSURE Synthesizing what the patient told you They hear in their own words Ask about the next step (action plan) If the patient is not ready for change, accept that

30 SHARED AGENDA SETTING Ask about the patient s concerns and priorities Offer choices

31 SHARED AGENDA SETTING We could talk about fast food, physical activity, or screen time. Which would you prefer to discuss?

32 CHANGE TALK changetalk/ Change_Talk_AAP_Kognito _Overview.pdf

33

34 MOTIVATIONAL INTERVIEWING Patient-centered Change Talk explores ambivalence Elicits inner motivations

35 MOTIVATIONAL INTERVIEWING Empowering Engaging Respectful Collaborative

36 QUESTIONS? Polina Sayess, MD Change_Talk_AAP_Kognito_Overview.pdf