Feature

Motivational interviewing and helping to manage the complexity of multimorbidity


Amanda Lyons


7/02/2018 2:59:48 PM

Motivational interviewing techniques present GPs with an alternative to ‘assess and advise’ when working with patients experiencing multimorbidity.

A motivational interviewing conversation has a focus on collaboration between doctor and patient.
A motivational interviewing conversation has a focus on collaboration between doctor and patient.

The prevalence of multimorbidity – in which a person experiences two or more chronic conditions – is increasing in Australia, yet much of the country’s health system focuses mainly on single diseases.
 
‘If you’re dealing with a single-disease scenario, there’s often a really well structured, well-developed clinical pathway that you can follow,’ Kylie McKenzie, clinical psychologist and trainer for the Motivational Interviewing Network of Trainers, told newsGP.
 
‘But if you’re dealing with somebody living with more than one complex chronic health condition, they’re likely to have guidelines for each of their diseases that don’t necessarily cross over in a neat way. And it can be quite overwhelming for people to follow the guidelines for multiple conditions.’
 
A patient-centred approach, recommended for patients with multimorbidity, differs from a more ‘traditional’ practice in which the GP provides advice with the expectation the patient will follow it.
 
McKenzie believes that while some may find it difficult to implement such a different approach to working with patients, the technique of motivational interviewing can offer a helpful solution. She hopes a new paper on which she is the lead author, ‘Guiding patients through complexity: Motivational interviewing for patients with multimorbidity’, in the latest edition of the Australian Journal of General Practice (AJGP) will provide some helpful guidance.
 
‘A motivational interviewing conversation has a focus on collaboration and empathy and is trying to get to a place where the person who has the health condition is driving the change,’ McKenzie said. ‘It’s a move away from the model of “assess and advise” to something that’s more engaging and focused on what a person knows about themselves, rather than telling people what to do.’
 
Patient ambivalence towards behaviour change is one of the reasons the traditional model can sometimes be less effective, especially in managing multimorbidity.
 
‘When you tell people what to do, what happens, paradoxically, is you elicit from them the other side of the argument,’ McKenzie said. ‘As people, we know we probably should change and that we’d benefit from it, but it’s hard to do and there’s another part of us that doesn’t really want to.’
 
But motivational interviewing offers a different approach that can prove more helpful for this particular patient population.
 
‘The potential for motivational interviewing is that it describes patient-centred skills; so it breaks down ways in which you can respond to patients,’ McKenzie said. ‘It describes skills of asking questions that are promoting of change or more engaging, and it provides some ideas about more effective advice-giving.’
 
McKenzie understands the apprehensions practitioners may have about using the technique.
 
‘I think the fear is that if you change the seemingly more efficient approach of asking diagnostic questions and providing specific advice, the session will become quite long and unhelpful,’ she said.
 
However, McKenzie believes that if applied correctly, motivational interviewing can actually deliver greater efficiency.
 
‘If you can ask questions of a patient presenting with multimorbid complexity in a way that engages them in their own care, and in a specific and targeted way towards health behaviour change, then I think the time is actually more productively spent,’ she said.
 
A common misconception about motivational interviewing is that it involves completely open questioning, but the best results actually require the guidance and knowledge of a trained healthcare professional.
 
‘Our role [as healthcare professionals] with motivational interviewing is to guide patients based on the empirically-based medical evidence, because that’s what we bring to the conversation, whereas the patient brings their knowledge about themselves,’ McKenzie said.
 
McKenzie believes the communication itself can ultimately be the spark that leads a patient to healthy change.
 
‘The conversation you have with a patient could be not just the transfer of knowledge, but the intervention that starts people on a pathway to a healthier life,’ she said.
 
Access Kylie McKenzie’s paper in the latest edition of AJGP for further information on motivational interviewing techniques for patients with multimorbidity.



ajgp motivational-interviewing multimorbidity





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