ABSTRACT
CONTEXT: 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. OBJECTIVES: 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. CONCLUSION: 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.
