Objective:
Patient health outcomes are strongly correlated with management of their health condition. In chronic disease management, example hemophilia, a clinician often encounters situations where despite what the patient is instructed to do, there is resistance to follow directions, thus compromising the potential benefits of their treatment regimen.
The objective of these interventions was to test out motivational interviewing (MI) as an alternative communication approach to traditional advice -giving in especially difficult, yet common, hemophilia patient situations.
Methods:
Four case studies are reported, each with a different nurse, patient, and desired behavioral change. In each case study, the clinician had received education on the use of MI in health care settings. Multiple Tools and Paradigms were used with patients at different life stages, and in need of making changes in their self-care and disease management. The clinicians avoided traditional directive approaches and adopted collaborative methods that guided the patient to take responsibility for achieving their own health goals. Patients were followed post intervention to determine longevity of the success achieved through this intervention.
Results Summary:
In each case, the use of MI enabled the clinician to work collaboratively with the patient or caregiver, to evoke their own reasons for change, to elicit change planning, and to mobilize them towards healthier choices in managing their condition.
Case study 1: pediatric setting - Use of Engaging MicroskillsMicro skills (Open Questions, Affirmations, Reflections, Summaries) with a parent to empower their child to start self infusion.
Case study 2: pediatric setting - Use of MI Rulers to motivate an adolescent to choose a more appropriate sport activity.
Case study 3: Transition setting - Use of MI Spirit, especially partnership and honoring autonomy, with an adolescent.
Case study 4: Adult setting - Use of EPE (Elicit Provide Elicit Approach) with an adult who was not adherent to his prophylaxis regimen.
Conclusions:
MI was confirmed as a successful therapeutic approach with a variety of resilient clinical cases where traditional directive approaches had been unsuccessful. The use of MI created an open and trusted communication channel between the clinician and the patient or caregiver, concluding with a change plan agreement. Clinicians felt more fulfilled with their jobs and more satisfied with the result of their intervention. With appropriate education about this methodology, clinicians can use it with their patients where a behavioral change is required to achieve better therapeutic outcomes.