Motivational Interviewing in Palliative Care
Condition: Motivational Interviewing
Study type: Interventional

Summary: 
      Patients with advanced illness and their families confront a number of issues ranging from
      distressing symptoms to making complex decisions that affect quality of life and survival.
      Patients and family members struggle with these decisions even more when they feel
      ambivalence or reluctance. The investigator's overarching goal is to enhance provision of
      high quality, patient-centered care for patients with advance illness and their families and
      to reduce burnout among palliative care clinicians. The investigator will apply a
      well-established approach to achieving clinician/patient alignment in the primary care
      setting, Motivational Interviewing (MI) to a new population and setting, palliative care.
    

Detailed description: 
      The investigator will use a 2-arm randomized wait-list control design with up to 30
      palliative care clinicians (15 in each arm). Clinicians in the intervention arm will be
      taught Motivational Interviewing (MI) via a coaching model in which a didactic session is
      followed by feedback through review of clinicians' audio-recorded encounters. Clinicians in
      both arms will audio record 4 encounters with patients with advanced illness and their family
      caregivers. The patients/caregivers will be provided with a 1-page information sheet about
      the study and will sign a HIPAA B form which will allow the study team to record a palliative
      care encounter and allow the research assistant to administer a short survey immediately
      within 1-2 days following a palliative care encounter to assess the effect of integrating MI
      techniques on perceived empathy and satisfaction with the encounter. The investigators will
      also assess clinician satisfaction with the encounter. Clinician burnout will be assessed at
      the time of study enrollment and following completion of all study encounter recordings.
      Clinicians randomized to the wait-list control arm will receive MI coaching only after they
      have recorded 4 study encounters. The wait-list control study design was selected to give all
      participating clinicians access to motivational interviewing coaching.

      Intervention: The investigator is comparing standard palliative care communication skills
      enhanced by Motivational Interviewing coaching to standard palliative care. Given that
      palliative care is currently the gold standard for clinician communication in the setting of
      serious and advanced illness, if Motivational Interviewing coaching improves encounters for
      palliative care clinicians, it is even more likely to do so for other clinicians who care for
      people with advanced illness. The investigator has adopted a "coaching" model that includes
      both didactic and individual feedback. The coaching approach maps to Social Cognitive Theory
      in that its purpose is to build skills and improve self-efficacy or confidence to use the
      techniques. Participating palliative care clinicians randomized to the intervention arm will
      receive Motivational Interviewing coaching immediately. Those randomized to the wait-list
      control arm will receive Motivational Interviewing coaching after the study encounters and
      data collection have been completed. The intervention consists of several components: 1)
      1-hour face-to-face (in person or via Skype) didactic session in which a Motivational
      Interviewing coach explains tenets of Motivational Interviewing and specifics, particularly
      addressing ambivalence and reluctance. This session will be recorded for future broader
      dissemination; 2) 1-hour individual session via Skype, including individualized goal-setting;
      3) Clinician audio records 2 encounters, which are transcribed. The Motivational Interviewing
      coach then codes the encounters and meets with the clinician via Skype for 30 minutes to give
      feedback and coaching; 4) Clinician audio records 2 additional encounters and again receives
      individualized feedback and coaching. At the end of the interactive Motivational Interviewing
      didactic, each clinician who is randomized to the intervention arm will set an individual
      goal for which Motivational Interviewing technique he/she wants to try.

      Each clinician will then audio record 2 palliative care encounters; audio recordings will be
      transcribed. The Motivational Interviewing coach will listen to the recordings and code the
      transcriptions paying attention to the clinician's stated goal. The coach will conduct 1:1
      Skype calls to review audio-recorded encounters and provide individualized feedback and
      coaching. During the feedback sessions, the coach will provide positive feedback on the
      Motivational Interviewing techniques used, paying most attention to the technique the
      clinician set as his/her individual target technique. The coach will also offer feedback on
      parts of the encounter when Motivational Interviewing could have been applied. At the end of
      the session, the coach will ask the clinician to set another individual goal for which
      Motivational Interviewing technique they want to try and repeat the process of having them
      audio record 2 additional palliative care encounters and providing individualized feedback
      and coaching. After each clinician has finished the intervention, the investigators will
      obtain extensive process data from clinicians to learn what went well about the coaching and
      what can be improved to plan for future refinement and study. To plan for future scalability,
      the investigators will simultaneously be developing a coaching manual that will be used to
      train others to serve as Motivational Interviewing coaches.

      Wait List Control: Clinicians who are randomized to the wait-list control arm will audio
      record 4 palliative care encounters, which will be transcribed, and have an individual
      coaching and feedback session in which the Motivational Interviewing coach will review their
      audio-recorded encounters following completion of study data collection.
    

Intervention name(s): Motivational Interviewing; Wait-list control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Clinicians in the intervention arm will be taught Motivational Interviewing via a coaching model in which a didactic session is followed by feedback through review of clinicians' audio-recorded encounters.; After consent, clinicians in the wait-list control arm will complete a survey to self-assess their motivational interviewing skills and burnout.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Palliative Care