Motivational Interviewing to Address Reluctance and Ambivalence in Palliative Care
Palliative care clinicians often talk to patients and families about difficult topics like quality of life and/or survival. These discussions can be complicated by patients or family caregivers expressing ambivalence about prioritizing goals or feeling reluctant to discuss these topics. Palliative care clinicians need evidence-based tools to help them with these challenging conversations. This project will pilot test an intervention designed to improve palliative care clinicians’ skills in interactions in which patients and caregivers express reluctance or ambivalence. The proposed project aligns with the NPCRC priority area: “Studying methods of improving communication between persons living with serious illness, their families, and their health care providers.” Motivational interviewing (MI) offers tools to address ambivalence and reluctance. MI, which was designed to guide behavior change conversations, has increasingly been adopted by primary care clinicians. It has not, however, been routinely integrated into palliative care. This proof of concept pilot trial is designed to test the feasibility, acceptability, and preliminary efficacy of integrating MI techniques into palliative care. We chose palliative care clinicians because our pilot work indicates they are interested in learning MI and find many of their interactions involve ambivalent or reluctant patients and families. Our premise is that enhancing standard palliative care communication with MI techniques will improve patient, caregiver and clinician experiences and outcomes. Dr. Pollak’s pilot work in the primary care setting indicates that MI coaching reduces clinician burnout, an important outcome that will motivate health care systems to adopt the training. If successful, the approach could be scaled to include non-palliative care clinicians who care for seriously ill patients and their families.
Dr. Kutner is a
tenured Professor of Medicine in the Divisions of General Internal Medicine
(GIM) and Geriatric Medicine in the Department of Medicine at the University of
Colorado School of Medicine (UC SOM). Dr. Kutner received her MD from the
University of California San Francisco (UCSF) in 1991 and completed residency
training in internal medicine at UCSF in 1994. Subsequently, she completed a
NRSA primary care research fellowship, earning an MSPH degree with honors, and
a fellowship in geriatric medicine at UC SOM (1994-1997). She is Board
Certified in internal medicine, geriatric medicine and hospice and palliative
medicine and cares for patients on the palliative care service and in general
internal medicine clinic. Her research focuses on improving symptoms and
quality of life for patients with serious illness and their family caregivers.
Dr. Kutner is Co-Chair of the NIH-funded Palliative Care Research Cooperative
Group (PCRC). She was a member of the Institute of Medicine (IOM) Transforming
End of Life Care Committee and is a past-president of the American Academy of
Hospice and Palliative Medicine (AAHPM). Dr. Kutner served as the Head of the
University of Colorado Division of General Internal Medicine from 2002 until 2014.
Dr. Kutner became the Chief Medical Officer of University of Colorado Hospital
and Associate Dean for Clinical Affairs, UC SOM in July 2014.