title: Patient and Caregiver Opinions of Motivational Interviewing Techniques In Role-Played Palliative Care Conversations: A Pilot Study.
abstract: BACKGROUND
  Although many have examined the role of motivational interviewing (MI) in diverse health care encounters, no one has explored whether patients and caregivers facing serious illnesses identify specific MI techniques as helpful.
  
  
  OBJECTIVE
  The aim of this pilot study was to describe how patients and caregivers perceived MI techniques in palliative care role-play encounters.
  
  
  METHODS
  About 21 patients and caregivers participated in a role-play encounter where we asked the participant to act out being ambivalent or reluctant regarding the goals of care decision. The participant met with either an MI-trained physician or a physician who was not trained in MI (usual care). After the simulated encounter, we conducted cognitive interviews ("think-aloud" protocol) asking participants to identify "helpful" or "unhelpful" things physicians said. Participants also completed a perceived empathy instrument as a fidelity test of the MI training of the physician.
  
  
  RESULTS
  Qualitative analyses revealed that participants independently identified the following helpful communication elements that are consistent with core MI techniques: reflection and validation of values, support of autonomy and flexibility, and open questions acting as catalysts for discussion. Participants rated the MI-trained physician slightly higher on the perceived empathy scale.
  
  
  CONCLUSIONS
  This pilot study represents the first exploration of patient and caregiver perceptions of helpful techniques in palliative care conversations. Use of MI techniques shows promise for improving palliative care discussions.
authors.affiliation: Cancer Control and Population Sciences, Duke Cancer Institute, Durham, North Carolina, USA; Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina, USA. Electronic address: kathryn.pollak@duke.edu.
authors.forename: Kathryn I
authors.initials: KI
authors.lastname: Pollak
authors.affiliation: College of Nursing, University of Colorado, Aurora, Colorado, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jones
authors.affiliation: Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Hillary D
authors.initials: HD
authors.lastname: Lum
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: De La Cruz
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Susanne
authors.initials: S
authors.lastname: Felton
authors.affiliation: Department of Palliative Care, Kaiser Permanente, Denver, Colorado, USA.
authors.forename: Arvin
authors.initials: A
authors.lastname: Gill
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Jean S
authors.initials: JS
authors.lastname: Kutner
mesh_terms: D000368:Aged; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D003142:Communication; D003657:Decision Making; D004645:Empathy; D005260:Female; D006801:Humans; D008297:Male; D062405:Motivational Interviewing / Q000379:methods*; D010166:Palliative Care / Q000379:methods* / Q000523:psychology*; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D010865:Pilot Projects
keywords: Motivational interviewing; empathy; palliative care; patient perceptions