Motivational Interviewing in Palliative Care
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - 100 |
| Updated: | 10/18/2018 |
| Start Date: | October 24, 2017 |
| End Date: | June 30, 2019 |
| Contact: | Sue Felton, MA |
| Email: | sue.felton@ucdenver.edu |
| Phone: | 3037242253 |
Motivational Interviewing to Address Reluctance and Ambivalence in Palliative Care
Patients with advanced illness and their families confront a number of issues ranging from
distressing symptoms to making complex decisions that affect quality of life and survival.
Patients and family members struggle with these decisions even more when they feel
ambivalence or reluctance. The investigator's overarching goal is to enhance provision of
high quality, patient-centered care for patients with advance illness and their families and
to reduce burnout among palliative care clinicians. The investigator will apply a
well-established approach to achieving clinician/patient alignment in the primary care
setting, Motivational Interviewing (MI) to a new population and setting, palliative care.
distressing symptoms to making complex decisions that affect quality of life and survival.
Patients and family members struggle with these decisions even more when they feel
ambivalence or reluctance. The investigator's overarching goal is to enhance provision of
high quality, patient-centered care for patients with advance illness and their families and
to reduce burnout among palliative care clinicians. The investigator will apply a
well-established approach to achieving clinician/patient alignment in the primary care
setting, Motivational Interviewing (MI) to a new population and setting, palliative care.
The investigator will use a 2-arm randomized wait-list control design with up to 30
palliative care clinicians (15 in each arm). Clinicians in the intervention arm will be
taught Motivational Interviewing (MI) via a coaching model in which a didactic session is
followed by feedback through review of clinicians' audio-recorded encounters. Clinicians in
both arms will audio record 4 encounters with patients with advanced illness and their family
caregivers. The patients/caregivers will be provided with a 1-page information sheet about
the study and will sign a HIPAA B form which will allow the study team to record a palliative
care encounter and allow the research assistant to administer a short survey immediately
within 1-2 days following a palliative care encounter to assess the effect of integrating MI
techniques on perceived empathy and satisfaction with the encounter. The investigators will
also assess clinician satisfaction with the encounter. Clinician burnout will be assessed at
the time of study enrollment and following completion of all study encounter recordings.
Clinicians randomized to the wait-list control arm will receive MI coaching only after they
have recorded 4 study encounters. The wait-list control study design was selected to give all
participating clinicians access to motivational interviewing coaching.
Intervention: The investigator is comparing standard palliative care communication skills
enhanced by Motivational Interviewing coaching to standard palliative care. Given that
palliative care is currently the gold standard for clinician communication in the setting of
serious and advanced illness, if Motivational Interviewing coaching improves encounters for
palliative care clinicians, it is even more likely to do so for other clinicians who care for
people with advanced illness. The investigator has adopted a "coaching" model that includes
both didactic and individual feedback. The coaching approach maps to Social Cognitive Theory
in that its purpose is to build skills and improve self-efficacy or confidence to use the
techniques. Participating palliative care clinicians randomized to the intervention arm will
receive Motivational Interviewing coaching immediately. Those randomized to the wait-list
control arm will receive Motivational Interviewing coaching after the study encounters and
data collection have been completed. The intervention consists of several components: 1)
1-hour face-to-face (in person or via Skype) didactic session in which a Motivational
Interviewing coach explains tenets of Motivational Interviewing and specifics, particularly
addressing ambivalence and reluctance. This session will be recorded for future broader
dissemination; 2) 1-hour individual session via Skype, including individualized goal-setting;
3) Clinician audio records 2 encounters, which are transcribed. The Motivational Interviewing
coach then codes the encounters and meets with the clinician via Skype for 30 minutes to give
feedback and coaching; 4) Clinician audio records 2 additional encounters and again receives
individualized feedback and coaching. At the end of the interactive Motivational Interviewing
didactic, each clinician who is randomized to the intervention arm will set an individual
goal for which Motivational Interviewing technique he/she wants to try.
Each clinician will then audio record 2 palliative care encounters; audio recordings will be
transcribed. The Motivational Interviewing coach will listen to the recordings and code the
transcriptions paying attention to the clinician's stated goal. The coach will conduct 1:1
Skype calls to review audio-recorded encounters and provide individualized feedback and
coaching. During the feedback sessions, the coach will provide positive feedback on the
Motivational Interviewing techniques used, paying most attention to the technique the
clinician set as his/her individual target technique. The coach will also offer feedback on
parts of the encounter when Motivational Interviewing could have been applied. At the end of
the session, the coach will ask the clinician to set another individual goal for which
Motivational Interviewing technique they want to try and repeat the process of having them
audio record 2 additional palliative care encounters and providing individualized feedback
and coaching. After each clinician has finished the intervention, the investigators will
obtain extensive process data from clinicians to learn what went well about the coaching and
what can be improved to plan for future refinement and study. To plan for future scalability,
the investigators will simultaneously be developing a coaching manual that will be used to
train others to serve as Motivational Interviewing coaches.
Wait List Control: Clinicians who are randomized to the wait-list control arm will audio
record 4 palliative care encounters, which will be transcribed, and have an individual
coaching and feedback session in which the Motivational Interviewing coach will review their
audio-recorded encounters following completion of study data collection.
palliative care clinicians (15 in each arm). Clinicians in the intervention arm will be
taught Motivational Interviewing (MI) via a coaching model in which a didactic session is
followed by feedback through review of clinicians' audio-recorded encounters. Clinicians in
both arms will audio record 4 encounters with patients with advanced illness and their family
caregivers. The patients/caregivers will be provided with a 1-page information sheet about
the study and will sign a HIPAA B form which will allow the study team to record a palliative
care encounter and allow the research assistant to administer a short survey immediately
within 1-2 days following a palliative care encounter to assess the effect of integrating MI
techniques on perceived empathy and satisfaction with the encounter. The investigators will
also assess clinician satisfaction with the encounter. Clinician burnout will be assessed at
the time of study enrollment and following completion of all study encounter recordings.
Clinicians randomized to the wait-list control arm will receive MI coaching only after they
have recorded 4 study encounters. The wait-list control study design was selected to give all
participating clinicians access to motivational interviewing coaching.
Intervention: The investigator is comparing standard palliative care communication skills
enhanced by Motivational Interviewing coaching to standard palliative care. Given that
palliative care is currently the gold standard for clinician communication in the setting of
serious and advanced illness, if Motivational Interviewing coaching improves encounters for
palliative care clinicians, it is even more likely to do so for other clinicians who care for
people with advanced illness. The investigator has adopted a "coaching" model that includes
both didactic and individual feedback. The coaching approach maps to Social Cognitive Theory
in that its purpose is to build skills and improve self-efficacy or confidence to use the
techniques. Participating palliative care clinicians randomized to the intervention arm will
receive Motivational Interviewing coaching immediately. Those randomized to the wait-list
control arm will receive Motivational Interviewing coaching after the study encounters and
data collection have been completed. The intervention consists of several components: 1)
1-hour face-to-face (in person or via Skype) didactic session in which a Motivational
Interviewing coach explains tenets of Motivational Interviewing and specifics, particularly
addressing ambivalence and reluctance. This session will be recorded for future broader
dissemination; 2) 1-hour individual session via Skype, including individualized goal-setting;
3) Clinician audio records 2 encounters, which are transcribed. The Motivational Interviewing
coach then codes the encounters and meets with the clinician via Skype for 30 minutes to give
feedback and coaching; 4) Clinician audio records 2 additional encounters and again receives
individualized feedback and coaching. At the end of the interactive Motivational Interviewing
didactic, each clinician who is randomized to the intervention arm will set an individual
goal for which Motivational Interviewing technique he/she wants to try.
Each clinician will then audio record 2 palliative care encounters; audio recordings will be
transcribed. The Motivational Interviewing coach will listen to the recordings and code the
transcriptions paying attention to the clinician's stated goal. The coach will conduct 1:1
Skype calls to review audio-recorded encounters and provide individualized feedback and
coaching. During the feedback sessions, the coach will provide positive feedback on the
Motivational Interviewing techniques used, paying most attention to the technique the
clinician set as his/her individual target technique. The coach will also offer feedback on
parts of the encounter when Motivational Interviewing could have been applied. At the end of
the session, the coach will ask the clinician to set another individual goal for which
Motivational Interviewing technique they want to try and repeat the process of having them
audio record 2 additional palliative care encounters and providing individualized feedback
and coaching. After each clinician has finished the intervention, the investigators will
obtain extensive process data from clinicians to learn what went well about the coaching and
what can be improved to plan for future refinement and study. To plan for future scalability,
the investigators will simultaneously be developing a coaching manual that will be used to
train others to serve as Motivational Interviewing coaches.
Wait List Control: Clinicians who are randomized to the wait-list control arm will audio
record 4 palliative care encounters, which will be transcribed, and have an individual
coaching and feedback session in which the Motivational Interviewing coach will review their
audio-recorded encounters following completion of study data collection.
Inclusion Criteria:
- Clinicians who are palliative care providers (physicians and Advanced Practice
Providers).
- Patients/family caregivers must be 18 - 100 years of age.
- Patients must have an advanced illness and be receiving palliative care.
- Family caregivers must be caring for a patient who has an advanced illness who is
receiving palliative care.
Exclusion Criteria:
- Patients/family caregivers who do not speak English or require interpreter services
will be excluded.
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