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motivational interviewing
Motivational interviewing is counseling using directive, patient-centered techniques.
The basic elements include engagement, focusing, evoking, & planning.
- exploits patient's intrinsic motivation to change
- identifies reasons for ambivalence to change
- discusses them but does not directly confront the patient
- patient must confront the discrepancy between his/her cuurent & desired behavior
Indications:
- overall goal is to assist patients in addressing & changing unhealthy behaviors
Clinical significance:
- patient chooses agenda
- provider is not in control
- provider does not tell patient what he/she should or should not do
- provider assesses patient's sense of importance of various issues & level of confidence in making changes
Procedure:
- Engage
- understand patient's behavior (be non-judgemental)
- confirm what the patient says
- avoid assumptions about patient's motivation
- Focus
- listen, encourage change as indicated
- be positive
- when patient speaks of sustaining current behavior
- elaborate
- affirm
- reflect
- Evoke
- help patient formulate & verbalize new goals
- offer suggestions if patient unable to do so
- Plan
- discuss goals*, resources, & means of monitoring progress
- identify barriers to success & develop plan(s) to overcome barriers
* goals should be specific, achievable, realistic & time-bound
General
medical history
References
- Medical Knowledge Self Assessment Program (MKSAP) 16, 19
American College of Physicians, Philadelphia 2012, 2022
- Rollnick S, Butler CC, Kinnersley P, Gregory J, Mash B.
Motivational interviewing.
BMJ. 2010 Apr 27;340:c1900
PMID: 20423957
- Mifsud JL, Galea J, Garside J, et al.
Motivational interviewing to support modifiable risk factor change in
individuals at increased risk of cardiovascular disease: a systematic
review and meta-analysis.
PLoS One. 2020;15:e0241193.
PMID: 33175849
- NEJM Knowledge+ Pain Management and Opioids: Recharge