Effect of teaching motivational interviewing via communication coaching on clinician and patient satisfaction in primary care and pediatric obesity-focused offices

Obesity in Adolescents: A Review

Importance

Obesity affects approximately 21% of US adolescents and is associated with insulin resistance, hypertension, dyslipidemia, sleep disorders, depression, and musculoskeletal problems. Obesity during adolescence has also been associated with an increased risk of mortality from cardiovascular disease and type 2 diabetes in adulthood.

Observations

Obesity in adolescents aged 12 to younger than 18 years is commonly defined as a body mass index (BMI) at the 95th or greater age- and sex-adjusted percentile. Comprehensive treatment in adolescents includes lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Lifestyle modification therapy, which includes dietary, physical activity, and behavioral counseling, is first-line treatment; as monotherapy, lifestyle modification requires more than 26 contact hours over 1 year to elicit approximately 3% mean BMI reduction. Newer antiobesity medications, such as liraglutide, semaglutide, and phentermine/topiramate, in combination with lifestyle modification therapy, can reduce mean BMI by approximately 5% to 17% at 1 year of treatment. Adverse effects vary, but severe adverse events from these newer antiobesity medications are rare. Surgery (Roux-en-Y gastric bypass and vertical sleeve gastrectomy) for severe adolescent obesity (BMI ≥120% of the 95th percentile) reduces mean BMI by approximately 30% at 1 year. Minor and major perioperative complications, such as reoperation and hospital readmission for dehydration, are experienced by approximately 15% and 8% of patients, respectively. Determining the long-term durability of all obesity treatments warrants future research.

Conclusions and Relevance

The prevalence of adolescent obesity is approximately 21% in the US. Treatment options for adolescents with obesity include lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Intensive lifestyle modification therapy reduces BMI by approximately 3% while pharmacotherapy added to lifestyle modification therapy can attain BMI reductions ranging from 5% to 17%. Surgery is the most effective intervention for adolescents with severe obesity and has been shown to achieve BMI reduction of approximately 30%.

Motivational Interviewing Implementation in Primary Care: A "Terrifying Challenge" Becoming a "Professional Revelation"

INTRODUCTION

Motivational interviewing (MI) is an evidence-based counseling approach within primary care. However, MI rarely translates to practice following introductory training programs, and a lack of evidence regarding its implementation persists today. This study describes primary care clinicians' professional transformation in implementing MI through interprofessional communities of practice (ICP-MI).

METHOD

Qualitative data collection involved the research journal, participant observation of four ICP-MIs (76 hours/16 clinicians), and focus groups. A general inductive approach was used for data analysis. Results were conceptualized based on the Consolidated Framework for Implementation Research.

RESULTS

Four processes of MI implementation in primary care are presented as a motivational endeavor: ambivalence, introspection, experimentation, and mobilization. The clinicians were initially ambivalent, taking into consideration the significant challenges involved. After introspecting actual practices, they realized the limits of their previous clinician-centered approaches. The experimentation of MI in the workplace followed and enabled clinicians to witness MI feasibility and its added value. Finally, they were mobilized to ensure MI sustainability in their practices/organization. Intrinsic factors of influence included the clinicians' personal traits and their perception about MI as a clinical priority. Organizational support was also a crucial extrinsic factor in encouraging the clinicians' efforts.

CONCLUSION

As described in a fragmented manner in previous studies, MI implementation processes and influencing factors are presented as integrated findings. Incorporating engaging educational activities to provide clinicians with motivational support and collaborating with health care organizations to plan appropriate resources should be considered in the development of MI implementation programs from the onset.

Interface Between Motivational Interviewing and Burnout

Background

The contemporary challenges of improving patient engagement in chronic disease management and addressing the growing problem of physician burnout are commonly viewed as separate issues. However, there is extensive evidence that person-centered approaches to patient engagement, such as motivational interviewing (MI), are associated both with better outcomes for patients and improved well-being for clinicians.

Methods

We conducted an exploratory survey study to ascertain whether resident physicians who perceive that they embrace and utilize the MI approach also report less burnout. A total of 318 residents in several specialties were invited via email to complete a 10-question survey about patient engagement and the experience of burnout. Frequencies and percentages were calculated for all categorical/ordinal variables to describe survey participants and question responses. Correlation coefficients were obtained to assess relationships between all burnout and engagement questions.

Results

A total of 79 residents completed the survey (response rate of 24.8%). There was broad agreement about the importance of patient engagement and the use of the MI approach, and approximately 60% of residents indicated that burnout was a problem. Two items related to residents' perceived use of MI were correlated with feeling a sense of personal accomplishment, one of the protective factors against burnout.

Conclusion

Consistent with other studies indicating that person-centered approaches are associated both with better patient outcomes and provider wellbeing, our data suggest that residents' self-reported use of the MI approach in patient care may be related to less burnout. It appears that training in the MI approach in graduate medical education may be simultaneously good for patient outcomes and good for resident well-being.

Long-term effects of motivational interviewing vs. traditional counseling on dog owners' adherence to veterinary dental home care: a three-year follow-up study

Introduction

Periodontal disease is one of the most common health issues in dogs. However, disease is largely preventable by eliminating dental plaque, best achieved by daily tooth brushing. Unfortunately, owner adherence is low to the recommendation of daily tooth brushing in dogs.

Objective

This study aimed to evaluate the impact of various communication strategies, traditional advice (TA) versus motivational interviewing (MI), and compare them to a control group receiving no additional communication (CG), on dog owners' performance of dental home care and the oral health of their dogs.

Methods

The study was conducted as a longitudinal clinical intervention study spanning 3 years, and involved 75 dog owners with young dogs who were randomly assigned to one of three groups: TA, MI, or CG. Intervention groups received annual telephone consultations based on their assigned methodology. A questionnaire was administered twice to all groups, and the dental health of the dogs was assessed at the study's conclusion.

Result

Tooth brushing frequency demonstrated a significant increase in the MI group compared to the CG group (p < 0.01), albeit with a relatively low occurrence of daily brushing among owners. Dental health assessment revealed a significantly lower plaque index in the MI group compared to the CG group (p < 0.05), and a lower calculus index in the TA group compared to the CG group (p < 0.01). No statistically significant differences were observed between the MI and TA groups in terms of dental health.

Conclusion

Regular veterinary communication appears to have a positive influence on dog owner adherence to veterinary recommendations concerning dental care in dogs. Communication with veterinarians (MI and traditional advice) improved owner knowledge, attitude, and decreased frequency of not brushing. Although dental health parameters improved, the effect size was small, suggesting the complexity of adherence. Personalized calls to dog owners offer potential for dental health improvement, warranting further comparison of MI with traditional advice.

Motivational interviewing for the management of child and adolescent obesity: a systematic literature review

BACKGROUND

Among children or adolescents with obesity, 40-70.5% will remain obese as adults according to their paediatric body mass index (BMI). The recommended management involves changes in their nutritional habits (diet, physical activity, and sedentary lifestyle). Motivational interviewing (MI), a patient-centred consultation, has proven its worth in many fields where acting on behaviours is essential.

AIM

To investigate the use and outcomes of MI in the management of children and adolescents who are overweight and obese.

DESIGN & SETTING

A systematic review evaluated MI in the management of children and adolescents who are overweight and obese.

METHOD

PubMed, Web of Science, Cochrane Library, and CISMeF were searched between January 2022 and March 2022 for following terms: 'motivational interviewing', 'overweight or obesity', 'children or adolescent' to identify randomised controlled trials (RCTs). Inclusion criteria were interventions involving MI in children or adolescents who were commonly (polygenically) overweight or obese. Exclusion criteria were: studies before 1991; and articles not written in English or French. The first stage of the selection process was carried out by reading the titles and abstracts. A second stage was carried out by reading the complete studies. A secondary inclusion of articles was carried out following the reading of bibliographic references, mainly from systematic reviews and meta-analyses. The data were summarised in synthetic tables based on the Population, Intervention, Comparison, Outcomes, and Study (PICOS) tool.

RESULTS

From 444 articles the review identified 26 RCTs. Statistically significant results were found for all criteria (anthropometric and behavourial) in both children and adolescents. Quality of life and depression scores were also improved. Parental presence in the interview appeared to be essential for children, whereas for adolescents, the supportive involvement of parents outside of the interviews seemed more appropriate. The frequency and duration of the interventions played a major role in obtaining results, as did the number of people involved, and the diversity of the places where they are taken care of.

CONCLUSION

MI seems promising for children and adolescents with overweight or obesity, within the framework of a comprehensive, multiprofessional, family management, carried out over a long period with regular consultations.

Adapting a communication coaching intervention for obstetric sonographers delivering unexpected news: A qualitative study

Introduction

Despite widespread recognition that communicating unexpected news during obstetric ultrasound examinations is challenging, there is a dearth of research investigating how to teach evidence-based communication to sonographers. Communication Coaching is a supportive, positive method that has previously been associated with improvements in communication, patient satisfaction, and reduced burnout in clinicians. However, to date, no study has coached sonographers. This study explored stakeholders' views on a proposed Communication Coaching intervention and used these data to adapt the intervention for use with qualified obstetric sonographers.

Methods

Semi-structured interviews were conducted with people who have a vested interest in unexpected news delivery and thematic analysis was conducted on the data. Eight sonographers, six people with lived experience of receiving unexpected news and six representatives from third-sector organisations who support expectant parents were recruited (18 women; 2 men, aged between 21 and 75 years).

Results

Participants viewed the planned Communication Coaching intervention favourably and suggested adaptations. The two main themes were (1) the practicalities of coaching, and (2) content. The first theme had four subthemes: (a) brief and flexible structure, (b) online modality, (c) sensitive and positive coach and (d) organisational awareness. The second theme had three subthemes: (a) specific language and behaviour recommendations, (b) adaptable to different service-users and situations and (c) confer relevant emotional skills and techniques.

Conclusions

Communication Coaching could be a feasible and acceptable intervention for qualified sonographers if specific, limited adaptations are made as recommended by the stakeholders. Further evaluation of the intervention in practice is necessary.

Behaviour change, the itchy spot of healthcare quality improvement: How can psychology theory and skills help to scratch the itch?

Despite the clear utility and transferability, National Health Service (NHS) quality improvement initiatives have yet to benefit fully from what is already known within health psychology. Thus far, evidence from established, seminal behaviour change theory and practice have been ignored in favour of newly developed models and frameworks. Further, whilst there is a growing interest in what is commonly referred to as 'human factors' of change and improvement, there is scant transferability of known psychologically informed implementation skills into routine NHS Improvement practice. The science and practice of healthcare improvement is growing, and the behaviour change aspect is critical to sustainable outcomes. Therefore, this paper offers practical guidance on how seminal psychological behaviour change theory and motivational interviewing (a person-centred skills-based approach specifically developed to support people through change) can be combined to better address individual and organisational change within a healthcare improvement context.

Drama Training as a Tool to Teach Medical Trainees Communication Skills: A Scoping Review

PURPOSE

Recognizing the similarities between the skills an actor needs and those required of a physician in clinical communication, medical educators have begun to create drama-based interventions to teach communication skills. The purpose of this scoping review was to summarize existing educational interventions that use drama training to teach medical trainees communication skills.

METHOD

The authors searched PubMed, CINAHL Plus, Embase, ERIC, and Web of Science Core Collection multiple times beginning in March 2020 through March 2022. Articles were included if they (1) described components of an educational intervention, (2) used an active intervention based on drama training, (3) stated a curricular goal of improving learners' communication skills, and (4) included medical trainee learners. Data extracted included the details of the targeted learners and educational interventions, assessment tools, and outcomes. The quality of each study was assessed.

RESULTS

Thirty articles met the inclusion criteria. Twenty-five (83%) articles included acting and improvisation exercises, 9 (30%) used some or all of the conventions of forum theater, and 3 (10%) used dramatic performance. The interventions included undergraduate, graduate, and continuing medical education learners. Most were elective and involved a member of the theatrical community. Although low overall study quality (average MERSQI score was 8.5) limited the strength of the evidence, of the 8 articles that evaluated learners' knowledge, skills, and/or behaviors, the majority showed an initial improvement in communication skills post-intervention.

CONCLUSIONS

This review is the first, to the authors' knowledge, to focus on the curricular goal of improving communication skills and to include a broader scope (beyond medical improv) of drama trainings. While the included articles represent a diverse group of interventions, generally they reported an outcome of improved communication skills in their learners. More high-quality studies are needed to determine best practices and the generalizability of drama-based initiatives.

Assessing the feasibility and acceptability of a peer-based communication coaching model among hospital clinicians

Objective

Communication coaching shows promise for improving clinician communication yet few have assessed the feasibility of having peers coach each other. We conducted a proof-of-concept study to test the feasibility and acceptability of a peer-based communication coaching program in an inpatient setting.

Methods

We trained three clinician communication coaches (two physicians and one physician assistant) and randomized half of the 27 clinicians working on the general medicine floor to receive coaching. The coaching involved shadowing and providing feedback on real-time encounters with patients. We collected data on feasibility of providing the coaching, quantitative and qualitative ratings of acceptability of the coaching both from the clinician and the coach perspective, and clinician burnout.

Results

We found the peer coaching to be feasible and acceptable. Quantitative and qualitative reports support the merit of the coaching; most clinicians who received the coaching reported making changes in their communication. Clinicians in the intervention arm reported less burnout than those who did not receive the coaching.

Conclusions

This proof-of-concept pilot showed that peer coaches can provide communication coaching and that clinicians and coaches viewed the coaching as acceptable and might change communication. The coaching also seems to show promise on burnout. We provide lessons learned and thoughts about how to improve the program.

Innovation

Teaching clinicians to coach each other is innovative. We conducted a pilot that shows promise for feasibility, acceptability of clinicians coaching each other to communicate better, and a signal that it can help improve clinician burnout.

Motivating Behavioral Change

Motivational interviewing (MI) allows medical providers and patients to have more productive conversations about changing health behaviors. MI helps patients talk themselves into changing by evoking discussion around change, thus resolving natural ambivalence. MI practitioners cultivate a spirit of MI and use specific skills and strategies to develop discrepancy between the patient's current behavior and their goals or values. This article discusses the flow of MI, the spirit and method of MI including specific skills and strategies, and important considerations in implementing MI.

Acceptability and feasibility of video-based coaching to enhance clinicians' communication skills with patients

BACKGROUND

Despite a growing call to train clinicians in interpersonal communication skills, communication training is either not offered or is minimally effective, if at all. A critical need exists to develop new ways of teaching communication skills that are effective and mindful of clinician time pressures. We propose a program that includes real-time observation and video-based coaching to teach clinician communication skills. In this study, we assess acceptability and feasibility of the program using clinician interviews and surveys.

METHODS

The video-based coaching intervention targets five patient-centered communication behaviors. It uses trained communication coaches and live feed technology to provide coaching that is brief (less than 15 min), timely (same day) and theory-informed. Two coaches were trained to set up webcams and observe live video feeds of clinician visits in rooms nearby. As coaches watched and recorded the visit, they time stamped illustrative clips in real time. Video clips were a critical element of the program. During feedback sessions, coaches used video clips to promote discussion and self-reflection. They also used role play and guided practice techniques to enforce new tips. Clinicians included residents (n = 15), fellows (n = 4), attending physicians (n = 3), and a nurse practitioner (n = 1) at two primary care clinics in Houston, Texas. We administered surveys to clinicians participating in the program. The survey included questions on quality and delivery of feedback, and credibility of the coaches. We also interviewed clinicians following the intervention. We used rapid analysis to identify themes within the interviews.

RESULTS

Survey measures showed high feasibility and acceptability ratings from clinicians, with mean item scores ranging from 6.4 to 6.8 out of 7 points. Qualitative analysis revealed that clinicians found that 1) coaches were credible and supportive, 2) feedback was useful, 3) video-clips allowed for self-reflection, 4) getting feedback on the same day was useful, and 5) use of real patients preferred over standardized patients.

CONCLUSIONS

Video-based coaching can help clinicians learn new communication skills in a way that is clinician-centered, brief and timely. Our study demonstrates that real-time coaching using live feed and video technology is an acceptable and feasible way of teaching communication skills.

Antimicrobial use in agriculture: critical review of the factors influencing behaviour

Antimicrobial resistance (AMR) is a global health emergency affecting humans and animals, diminishing the effectiveness of medication used to treat illness. The agri-food sector has attracted increased attention for imprudent antimicrobial use (AMU) and its contribution to AMR. Thus, ascertaining farmers' and veterinarians' behaviours surrounding AMU is essential to address imprudent AMU and generate behaviour change within the agri-food sector. Therefore, the aim of this critical review is to investigate, assess and collate the current body of evidence to identify psychosocial factors including knowledge, understanding, perceptions, attitudes and behaviours surrounding AMU. Database searches were limited to articles utilizing qualitative and quantitative methodologies, available in English with no restriction on publication year. Of the 1156 articles identified, 103 were retained for this review. Findings on the psychosocial aspects were thematically analysed. Five key themes emerged from the data: (i) knowledge and awareness of antimicrobials; (ii) attitudes towards antimicrobials; (iii) influential relationships; (iv) resources; and (v) factors influencing AMU. Results indicated that to overcome barriers experienced by key stakeholders, a carefully considered, evidence-based approach, incorporating behaviour change theory, is required when designing intricate interventions/strategies, in order to elicit successful and sustained AMU behaviour change.

PositiveLinks and the COVID-19 Response: Importance of Low-Barrier Messaging for PLWH in Non-urban Virginia in a Crisis

PositiveLinks (PL) is an evidence-based mobile health intervention promoting engagement in care for people living with HIV. PL offers secure, in-app patient-provider messaging. We investigated messaging during the early COVID-19 pandemic, comparing messages exchanged between 01/13/2020 and 03/01/2020 (“Pre-COVID”) to messages exchanged between 03/02/2020 and 04/19/2020 (“early COVID”) using Poisson regression. We performed qualitative analysis on a subset of messages exchanged between 02/01/2020 and 03/31/2020. Between “Pre-COVID” and “early COVID” periods, weekly member and provider messaging rates increased significantly. Of the messages analyzed qualitatively, most (53.3%) addressed medical topics, and more than a fifth (21.3%) addressed social issues. COVID-related messages often focused on care coordination and risk information; half of COVID messages contained rapport-building. PL patients (“members”) and providers used in-app secure messaging to reach out to one another, identifying needs, organizing receipt of healthcare resources, and strengthening patient-care team relationships. These findings underscore the importance of low-barrier messaging during a crisis.

Transitioning a home-based, motivational interviewing intervention among families to remote delivery during the COVID-19 pandemic: Key lessons learned

OBJECTIVE

This study examined the experiences, learnings, and strategies of Health Educators (HE) as they transitioned from a home-based model for motivational interviewing (MI) to remote delivery during COVID-19. The overall goal of this paper is to identify key lessons learned to help inform future delivery of remote MI delivery.

METHODS

HE perceptions and experiences regarding the transition from in-person to remote delivery of MI for 21 families were captured through a video recorded discussion. Thematic analysis was used to identify themes and subthemes and key learnings from the transition experience.

RESULTS

Five themes were identified including: 1) Impact of COVID-19 on families; 2) Scheduling, no-shows, and cancellations; 3) Preference of online video versus phone; 4) Building rapport with remote delivery; 5) HE work satisfaction. Based on these results, several key learnings were identified to improve remote MI-counseling, including using online video platforms versus phone calls, providing families the necessary information and technical support to improve acceptability, using specific strategies to enhance rapport and child engagement, and asking probing questions to elicit deeper reflection.

CONCLUSION

Specific considerations regarding rapport building including more frequent check-ins to demonstrate commitment to the family's success, and effective communication strategies including asking more probing questions that elicit complex reflection can support successful transition of MI-counseling from in-person to remote delivery among families with young children.

PRACTICE IMPLICATIONS

Our practice recommendations based on key learnings from MI practitioners during the transition from in-person to remote MI-counseling can support healthcare professionals looking to transition MI-counseling services to remote delivery.

Effect of interventions for the well-being, satisfaction and flourishing of general practitioners-a systematic review

OBJECTIVES

Clinician well-being has been recognised as an important pillar of healthcare. However, research mainly addresses mitigating the negative aspects of stress or burnout, rather than enabling positive aspects. With the added strain of a pandemic, identifying how best to maintain and support the well-being, satisfaction and flourishing of general practitioners (GPs) is now more important than ever.

DESIGN

Systematic review.

DATA SOURCES

We searched MEDLINE, PsycINFO, Embase, CINAHL and Scopus from 2000 to 2020.

STUDY SELECTION

Intervention studies with more than 50% GPs in the sample evaluating self-reported well-being, satisfaction and related positive outcomes were included. The Cochrane Risk of Bias 2 tool was applied.

RESULTS

We retrieved 14 792 records, 94 studies underwent full-text review. We included 19 studies in total. Six randomised controlled trials, three non-randomised, controlled trials, eight non-controlled studies of individual or organisational interventions with a total of 1141 participants. There were two quasi-experimental articles evaluating health system policy change. Quantitative and qualitative positive outcomes were extracted and analysed. Individual mindfulness interventions were the most common (k=9) with medium to large within-group (0.37-1.05) and between-group (0.5-1.5) effect sizes for mindfulness outcomes, and small-to-medium effect sizes for other positive outcomes including resilience, compassion and empathy. Studies assessing other intervention foci or other positive outcomes (including well-being, satisfaction) were of limited size and quality.

CONCLUSIONS

There is remarkably little evidence on how to improve GPs well-being beyond using mindfulness interventions, particularly for interventions addressing organisational or system factors. This was further undermined by inconsistent reporting, and overall high risk of bias. We need to conduct research in this space with the same rigour with which we approach clinical intervention studies in patients.

PROSPERO REGISTRATION NUMBER

CRD42020164699.

FUNDING SOURCE

Dr Diana Naehrig is funded through the Raymond Seidler PhD scholarship.

Advancing Motivational Interviewing Training with Artificial Intelligence: ReadMI

BACKGROUND

Motivational interviewing (MI) is an evidence-based, brief interventional approach that has been demonstrated to be highly effective in triggering change in high-risk lifestyle behaviors. MI tends to be underutilized in clinical settings, in part because of limited and ineffective training. To implement MI more widely, there is a critical need to improve the MI training process in a manner that can provide prompt and efficient feedback. Our team has developed and tested a training tool, Real-time Assessment of Dialogue in Motivational Interviewing (ReadMI), that uses natural language processing (NLP) to provide immediate MI metrics and thereby address the need for more effective MI training.

METHODS

Metrics produced by the ReadMI tool from transcripts of 48 interviews conducted by medical residents with a simulated patient were examined to identify relationships between physician-speaking time and other MI metrics, including the number of open- and closed-ended questions. In addition, interrater reliability statistics were conducted to determine the accuracy of the ReadMI's analysis of physician responses.

RESULTS

The more time the physician spent talking, the less likely the physician was engaging in MI-consistent interview behaviors (r = -0.403, p = 0.007), including open-ended questions, reflective statements, or use of a change ruler.

CONCLUSION

ReadMI produces specific metrics that a trainer can share with a student, resident, or clinician for immediate feedback. Given the time constraints on targeted skill development in health professions training, ReadMI decreases the need to rely on subjective feedback and/or more time-consuming video review to illustrate important teaching points.

[Impact of training on Motivational Interviewing (MI) for Family Physicians: Design and assessment of a Training Program (MOTIVA)]

AIM

To develop a training program in Motivational Interviewing for Family Physicians and assess the impact.

STUDY DESIGN

Multicenter, double blind and randomized clinical essay, with 2arms, Experimental (EG) and Control (CG) of Family Physicians with a follow up of 12 months.

LOCATION

32 Primary Healthcare Centers.

SAMPLE DESCRIPTION

54 physicians (CG=28, EG=26).

INTERVENTIONS

Training Program MOTIVA in ME with an initial presential course (16h), followed by online activities during 12months, and presential meetings (Problem BasedInterviewing with expert feedback).

MAIN MEASUREMENTS

Communicative skills in MI were assessed based on video-recordings (VR) with the EVEM 2.0 scale by peer reviewers. 236 VR with standardized patients and 96 VR with real patients.

RESULTS

Average results in EVEM scale (up to 56 points) at the beginning of the study were EG=21.27 (CI 95% 15.8-26.7) and CG=20.23 (CI95% 16.4-23.9) with no differences between both groups (P=.79). After the training, EG punctuation increased by 13.89 points (P<.001), average 35.16 (CI 95% 29.8-40.6). Real patients' VR in EG over a 12 month period keep their MI skills with an average of 36.9 points (CI 95% 30.3-43.6) versus CG 15.9 points (CI 95% 9.8-22.0). Once ended the MOTIVA Training Program, the EG maintains the acquired skills: final average EG=37.6 (CI 95% 33.2-41.1) versus CG=24.3 (CI95% 19.0-29.2) (P<.001).

CONCLUSIONS

The MOTIVA Training Program improves Motivational Interviewing skills, significatively improving after a presential course and sequential keep-alive activities. The effectiveness of the Program has been proven in the Third and Fourth steps of Miller's Pyramid.

Exploring Pediatric Obesity Training, Perspectives, and Management Patterns Among Pediatric Primary Care Physicians

OBJECTIVE

Significant variability exists in the amount of formal obesity training obtained by physicians caring for pediatric patients. The study objective was to assess the relationship between formal obesity training and pediatrics physicians' perceptions, practice patterns, overall knowledge, and confidence during management of pediatric obesity.

METHODS

An anonymous survey was distributed via email from February 2020 through March 2020 at a large academic system. Internal medicine/pediatrics (46 total) and pediatrics (104 total) primary care providers were selected. Data were collected on the total number of obesity-related training hours by quartiles, demographics, physicians' clinical practice patterns, and physicians' knowledge of pediatric obesity management, along with their perceptions, attitudes, and beliefs.

RESULTS

A total of 73 survey participants completed the survey: 69% were female, 77% were older than 40 years, and 74% were White. Physicians with the highest training were most likely to feel confident when managing pediatric obesity. However, only 20% of all physicians felt confident providing pre- and post-bariatric surgery care, and just 6% of physicians self-reported achieving management success.

CONCLUSIONS

Increased obesity training improves physicians' confidence and leads to familiarity with management guidelines. Formal obesity training should be prioritized during residency and beyond so that physicians who care for pediatric patients are better equipped to offer unbiased and effective care.

The approach to improving patient experience at children's hospitals: a primer for pediatric radiologists

Increasing attention is being given to improving patient experience in health care. Most children's hospitals have a patient experience office or team that champions and measures patient experience and partners with operations to optimize performance in this area. We outline the activities that our patient experience team undertakes at our pediatric health system to advocate for, measure and improve the experience of our patients and families. The framework we propose for such activities includes those that are proactive in improving patient experience as well as those that are reactive to when patients and families have had a poor experience. Those reactive practices are often centered on the management of patient complaints and grievances and early intervention into patient complaints so that they do not become grievances.

Learning motivational interviewing: prospects to preserve practitioners' well-being

Purpose

Motivational interviewing (MI) is a collaborative communication style designed to help clients achieve desired behavior changes. MI includes communication methods along with a mindset that avoids attempting to impose behavior change. Relying on the conservation of resources theory, this research report argues that learning MI helps practitioners communicate more effectively and preserve their own psychological health resources.

Design/methodology/approach

We tested whether MI training resulted in beneficial effects on practitioners' resilience and burnout (i.e. exhaustion and disengagement), surveying participants (N = 42) from various disciplines who learned MI at a training institute. Subjects received a questionnaire before and one month after MI training. The post-training questionnaire also assessed whether participants applied the training content in practice.

Findings

The results revealed that the training reduced participants' disengagement. Practical application was a predictor for this decrease as well as an increase in resilience.

Research limitations/implications

Due to the small sample size and self-reported data, this paper should be considered an experimental study that could inspire future research in this area, using more elaborate research designs.

Practical implications

Learning MI not only helps in facilitating behavior change in clients but also in bolstering practitioners' own resources. MI novices should aim to apply their newly acquired skills.

Originality/value

This study is among the first to explicitly hint at the possibility that learning MI helps practitioners preserve their psychological resources.

Feasibility of Using Communication Coaching to Teach Palliative Care Clinicians Motivational Interviewing

CONTEXT

Palliative care clinicians often have challenging conversations with patients or family caregivers who express ambivalence about goals or feel reluctant to discuss topics. Motivational Interviewing (MI) has tools to address ambivalence and reluctance.

OBJECTIVE

The aim of this pilot study was to test the feasibility, acceptability, and preliminary efficacy of an MI communication coaching intervention.

METHODS

We enrolled 22 palliative care clinicians and randomly assigned half to receive communication coaching versus wait-list control. The coaching entailed a lecture on MI, a 1:1 session to discuss applying MI, and audio recording and receiving feedback on four encounters (two separate times). Palliative care clinicians in the wait-list control arm audio-recorded four encounters. Coders blinded to study arm coded MI behaviors. We surveyed patients, caregivers, and clinicians after all audio-recorded encounters to assess perceptions of the encounter. The analyses were performed using a repeated-measures mixed model.

RESULTS

We found the intervention to be feasible and acceptable. Eighty-six percent of those enrolled completed all study activities including coaching sessions, audio-recording encounters, and completing surveys. Of those in the intervention arm, 88% rated the intervention as helpful and 100% would recommend it to a colleague. Compared to control clinicians, intervention clinicians had higher ratings of their MI skills after intervention, higher objectively rated communication skills, and slightly better burnout scores. We found no arm differences in patient, caregiver, or clinician ratings of satisfaction.

CONCLUSION

This pilot study indicates that coaching palliative care clinicians is feasible and shows promise that coaching can improve palliative care clinician communication.

Provider Practice and Perceptions of Pediatric Obesity in Appalachian Kentucky

OBJECTIVES

This study assessed providers' present practices and perceived needs in Appalachian Kentucky to identify the standard of care and implementation of expert recommendations for managing pediatric obesity.

METHODS

Questionnaire data were gathered from 28 providers at a pediatric obesity continuing medical education workshop in eastern Kentucky. We assessed current practices, perceived barriers to treatment, and needed resources for managing pediatric obesity.

RESULTS

Respondents reported mixed adherence to expert recommendations, with providers less frequently addressing family-reported barriers to change and assessing a family's readiness to change behaviors related to pediatric obesity. Respondents also reported service barriers related to patient motivation, lack of time with patients, and a lack of referral options. Finally, providers reported needing multiple community resources to better address pediatric obesity, including improved physical education programs, access to community recreation centers, additional referral resources for multidisciplinary care, and additional training in motivational techniques.

CONCLUSIONS

There remains a significant need for education and guidance regarding the implementation of expert recommendations for addressing pediatric obesity in Appalachian Kentucky. Providers reported needing multiple community resources, including improved physical education programs, access to community recreation centers, additional referral resources for multidisciplinary care, and additional training in motivational techniques. We discuss the implications for disseminating and implementing expert recommendations in rural eastern Kentucky, with an emphasis on the roles of behavioral health experts.

A Glaucoma-Specific Brief Motivational Interviewing Training Program for Ophthalmology Para-professionals: Assessment of Feasibility and Initial Patient Impact

Our objective was to test the feasibility of, fidelity to, and initial impact of a brief, glaucoma-specific motivational interviewing (MI) training program for ophthalmic para-professionals. This prospective, mixed-methods study had two components, one for staff and one for patients. Staff fidelity to MI principles was graded through audio-recorded encounters after initial and final training sessions. After training, patients graded staff for adherence to autonomy supportive care. Semi-structured interviews with para-professionals elicited feedback about the training and about their ability to implement MI in the clinic. The impact on patient satisfaction with staff communication, eye drop instillation self-efficacy, and overall health activation was assessed using a survey pre- and post-training. Para-professionals met two of three program goals for MI skills and improved in their overall scores for MI fidelity. Para-professionals noted lack of time in the clinic as a significant barrier to implementing counseling. Patient satisfaction with staff communication increased after the training (p = 0.04) among patients who rated their staff above the mean for providing autonomy supportive care. The intervention did not improve patients' eye drop instillation self-efficacy or overall health activation. Training para-professional staff in brief, glaucoma-specific MI techniques is feasible and may improve patient satisfaction, though dedicated time in clinic is needed to implement MI counseling into glaucoma practice.

Pilot Study to Improve Goals of Care Conversations Among Hospitalists

CONTEXT

Many hospitalized patients receive care that is not concordant with their goals. Teaching communication skills that better align goals and treatment can improve the care that patients receive.

OBJECTIVE

To develop and test an innovative approach that encourages hospitalists to engage in goals of care (GOC) conversations with their patients.

METHODS

We recruited 14 hospitalists and randomized half to receive electronic health record alerts for patients who might benefit most from a goals-of-care conversation, as well as communication coaching. The coaching required an initial meeting, then audio recording of two GOC conversations and feedback from the coach. Outcomes were the presence of GOC conversations (primary), the quality of the GOC conversations, physician perceptions of the intervention, and hospital metrics (e.g., 30-day readmissions, referrals to palliative care).

RESULTS

We did not increase the frequency of GOC conversations but did improve the quality of the conversations. Patients of physicians who received the intervention had fewer 30-day readmission rates and were less likely to die 90 days after admission than patients of physicians in the control arm. Patients of intervention physicians also had fewer palliative care consults than patients of control physicians.

CONCLUSIONS

Teaching hospitalists to have GOC conversations translated into better skills and outcomes for patients. This pilot study shows promise and should be tested in a larger trial.

Motivational interviewing with families in the home environment

OBJECTIVE

This study explored the feasibility and acceptability of using Motivational Interviewing (MI) in the home setting with families of preschoolers.

METHODS

Using mixed-methods pilot data from an MI-based obesity prevention intervention delivered via home visits by health educators (HEs) with 44 families (n = 17 four home visit group; n = 14 two home visit group), we examined: 1) fidelity of MI adherence by HEs; 2) parents' perceptions of the intervention; and 3) HEs insights pertaining to the intervention's delivery.

RESULTS

Multiple measures of MI fidelity were deemed to exceed defined proficiency levels. Ninety-three percent of families reported being "satisfied" to "very satisfied" with the intervention. HEs reported building a high level of trust with families and gaining a thorough understanding of familial context. Parents appreciated how HEs' were knowledgeable and provided personalized attention when discussing health goals. Some parents suggested more directive advice and follow-up visits as ways to improve the intervention.

CONCLUSION

Home-based MI was conducted with a high level of fidelity, was well accepted by families and practitioners.

PRACTICE IMPLICATIONS

Our findings from parents and MI practitioners provide key learnings that can inform future behavior change interventions that propose to use MI within the home setting.

Challenges and strategies for hypertension management: qualitative analysis of small primary care practices with varying blood pressure control

BACKGROUND

Electronic health record (EHR) data on blood pressure (BP) control among patients with hypertension show that practices' rates vary greatly. This suggests providers use different approaches in managing hypertension, and so we aimed to explore challenges small primary care practice providers face and strategies they use to manage patients' BP. We explored differences between providers with high and low BP control rates to help inform future quality improvement work.

METHODS

In 2015, we recruited practices in New York City with five or fewer providers. We employed a stratified purposeful sampling method, using EHR data to categorize small practices into groups based on the proportion of patients with hypertension whose last BP was <140/90: high control (>= 80%), average control (60-80%) and low control (<60%). We conducted semi-structured qualitative interviews with clinicians from 23 practices-7 high control, 10 average control and 6 low control-regarding hypertension management. We used a combined inductive/deductive approach to identify key themes, and these themes guided a comparison of high and low BP control providers.

RESULTS

Small practice providers reported treatment non-adherence as one of the primary challenges in managing patients' hypertension, and described using patient education, relationship building and self-management tools to address this issue. Providers differed qualitatively in the way they described using these strategies; high BP control providers described more actively engaging and listening to patients than low control providers did.

CONCLUSIONS

How providers communicate with patients may impact outcomes-future quality improvement initiatives should consider trainings to improve patient-provider communication.

Motivating residents to change communication: the role of a brief motivational interviewing didactic

INTRODUCTION

Motivational interviewing (MI) is a patient-centered approach that encourages patients to change behaviors. MI training programs have increased residents' knowledge and use of MI skills; however, many residency programs may not have the time to dedicate to lengthy MI programs. The purpose of this study was to evaluate the benefits of a brief MI didactic for residents in an academic internal medicine patient-centered medical home.

METHODS

Thirty-two residents completed a 1-h MI training between October 2016 and June 2017 and completed measures on their knowledge of, confidence using, and utilization of MI skills prior to the training, immediately after the training, and at a 1-month follow-up.

RESULTS

The residents' knowledge of and confidence using MI skills increased from pre-test to post-test and also increased from pre-test to the 1-month follow-up.

CONCLUSION

The utilization of MI skills increased from pre-test to the 1-month follow-up. A 1-h didactic offers benefits to residents.

Behavioral Counseling Training for Primary Care Providers: Immersive Virtual Simulation as a Training Tool

Behavioral counseling represents an efficacious approach for improving health behaviors on a population level, and the primary care setting is an appropriate context in which to implement this approach. However, evidence suggests that the utilization of behavioral counseling techniques in primary care, including those informed by motivational interviewing, is sub-optimal. Insufficient training has been cited as a barrier to utilizing counseling in the primary care setting. Recent work has evaluated the effectiveness of virtual simulations that can provide access to "virtual" patients while retaining the scalability inherent to a digital medium. However, these educational interventions have been limited to simulations delivered through a two-dimensional screen. More immersive simulations delivered through a head-mounted display can create a realistic practice environment that encompasses a learner's entire field of view, which may confer additional benefits with respect to training outcomes. The purpose of this short article is to briefly review the relevant literature across disciplines to conceptualize the potential effectiveness of this technology as a training tool for behavioral counseling. Immersive virtual simulations are designed to induce a psychological phenomenon referred to as presence, whereby a learner perceives themselves as existing within the virtual environment. As such, immersive virtual simulations can provide opportunities for practice, coaching, and feedback in an environment that closely approximates the clinical setting in which counseling will be delivered. Through its effects on presence, this technology may be particularly useful for developing empathy, which is an important component of counseling. Recommendations for future research are also provided.

An Ecological Approach to Understanding Preventive Service Utilization Among the Underserved

Preventive services have the potential to reduce health disparities; however, these services are underutilized, particularly among the underserved. Patients with low socioeconomic status and racial and ethnic minorities experience significant health disparities related to cancer and infectious and chronic diseases but face multilevel challenges accessing preventive care. The purpose of this article is to enhance understanding of preventive service utilization among underserved patients by providing an ecological framework that addresses factors at multiple levels that influence patient care. In addition to factors that directly impact the patient, the framework incorporates influences on the patient's experience of the health system.

Disseminating effective clinician communication techniques: Engaging clinicians to want to learn how to engage patients

Patient-clinician communication that promotes patient engagement enhances health care quality. Yet, disseminating effective communication interventions to practicing clinicians remains challenging. Current methods do not have large and sustainable effects. In this paper, we argue that both top-down approaches (mandated by institutions) should be coupled with bottom-up approaches that address clinician motivation, confidence, and barriers. We need to engage clinicians in the same way we ask them to engage patients - strategically and with empathy. We discuss potentially innovative strategies to integrate top-down and bottom-up approaches in ways that fit clinicians' busy schedules and can inform policy.

The association between parent-reported provider communication quality and child obesity status: Variation by parent obesity and child race/ethnicity

OBJECTIVE

To examine the association between healthcare provider communication quality and child obesity status, and the role of parent obesity and child race/ethnicity regarding this association.

METHODS

We conducted a cross-sectional secondary data analysis with the 2011-2013 Medical Expenditures Panel Survey of parents with children ages 6-12 (n=5390). We used multivariable logistic regression to examine the association of parent-reported healthcare provider communication quality (explaining well, listening carefully, showing respect, and spending enough time) with child obesity status, and effect modification by parent obesity and child race/ethnicity.

RESULTS

Parents of obese children were more likely to report that their child's healthcare provider listened carefully (OR=1.41, p=0.002) and spent enough time (OR=1.33, p=0.022) than parents of non-obese children. Non-obese parents of obese children experienced better communication in the domains of listening carefully (p<0.001) and spending enough time (p=0.007). Parents of obese non-Hispanic Asian children and non-Hispanic Black children were more likely to report that providers explained things well (p=0.043) and listened carefully (p=0.012), respectively.

CONCLUSION

Parents of obese children experienced better communication if parents were non-obese or children were non-Hispanic Black or Asian.

PRACTICE IMPLICATIONS

Healthcare providers should ensure effective communication with obese parents of obese children.

Efficacy of a Physician Assistant Student-Developed Behavior Change Program at a Local Free Clinic

PURPOSE

A quality assurance and quality improvement assessment was conducted to evaluate the efficacy of a behavior change program developed by physician assistant (PA) students at a local free clinic.

METHODS

Physician assistant students developed and implemented a program using motivational interviewing and healthy lifestyle behavioral counseling at a local free clinic. Twenty-eight patients participated in the program over 5 cohorts. A retrospective chart review was used to collect data.

RESULTS

Weight and body mass index (BMI) data were gathered retrospectively from patients' charts corresponding to the 6 months before the program, at the start of the program, at the end of the 12-week program, and at 3 and 6 months after the program. Significant differences were found between the start and end of the program for weight (P < .001) and BMI scores (P < .001). The mean weight decreased from 111.98 (standard deviation [SD] = 33.47) to 109.00 kg (SD = 33.93). The weight loss ranged from 0.45 to 9.53 kg, and 75% of participants lost weight. The mean BMI decreased from 41.21 (SD = 10.64) to 40.13 (SD = 10.98). Differences were maintained at 3- and 6-month follow-ups. However, only half the sample's data were available at follow-ups because some patients did not return to the free clinic during that time period.

CONCLUSIONS

A program facilitated by PA students and designed to help patients make healthy diet and exercise changes can be a valuable resource for free clinics and patients and an excellent clinical opportunity for PA students. To strengthen the program's commitment to maintenance of weight loss, program components of continued follow-up and engagement of patients should be explored and developed.