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Motivational interviewing
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One of the most difficult challenges of clinical endocrinology practice is inspiring our patients to adhere to recommendations for dietary modification, lifestyle change and pharmacotherapy.
The traditional information-based approach focuses on educating the patient so that they will understand why and how to change. The physician told the patient what was to be done and the patient was expected to follow this advice — without question. Those who did not follow recommendations were labeled “non-compliant.” Some providers use scare tactics in an attempt to frighten or bully patients into complying. Not surprisingly, this approach usually failed.
More recently, researchers have evaluated what successfully motivates people to change. This has led to a patient-centered, goal-oriented model of provider-patient interaction, known as motivational interviewing. This technique has been shown to be effective in improving adherence to recommendations for chronic disease management including behavioral modification and pharmacotherapy.
Motivational interviewing is based on three basic assumptions: Collaboration, evocation, and autonomy. By understanding and respecting these assumptions, practitioners establish rapport, reduce resistance, support autonomy, and elicit “change talk” — with the ultimate goal of improving clinical outcomes.
Patients appreciate when we try to understand their situation instead of simply telling them what to do. By showing that we value their autonomy, understand that it is their choice and are not trying to manipulate them into change, they are more likely to consider following our recommendations. By exploring ambivalence and barriers for adherence to therapy, we have a better understanding of why non-adherence may occur and how to avoid it. Finally, by involving the patient in developing their treatment plan, they have greater ownership and as a result are more likely to follow through.
Times have changed and I am glad they have.
Butterworth. J Manag Care Pharm. 2008;14:S21-S25.
Rollnick S. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guilford Press; 2007.