Duke Comprehensive Cancer Center, Cancer Prevention, Detection and Control Research Program, Durham, North Carolina, USA.
J Palliat Med. 2011 May;14(5):587-92. doi: 10.1089/jpm.2010.0495. Epub 2011 Feb 3.
Palliative care relies heavily on communication. Although some guidelines do address difficult communication, less is known about how to handle conversations with patients who express ambivalence or resistance to such care. Clinicians also struggle with how to support patient autonomy when they disagree with patient choices. Motivational Interviewing (MI) techniques may help address these responses. Specifically, MI techniques such as reflective statements and summarizing can help reduce a patient's resistance, resolve patient ambivalence, and support patient autonomy. Not all the MI techniques are applicable, however, in part because palliative care clinicians do not guide patients to make particular choices but, instead, help patients make choices that are consistent with patient values. Some elements from MI can be used to improve the quality and efficacy of palliative care conversations.
姑息治疗在很大程度上依赖于沟通。虽然有些指南确实涉及到困难的沟通，但对于如何处理那些对这种治疗表示矛盾或抵触的患者的谈话，人们知之甚少。临床医生也在努力应对如何在不同意患者选择的情况下支持患者的自主权。动机性访谈（MI）技术可能有助于解决这些问题。具体来说，MI 技术，如反映性陈述和总结，可以帮助减少患者的抵触，解决患者的矛盾，并支持患者的自主权。然而，并非所有的 MI 技术都适用，部分原因是姑息治疗临床医生不指导患者做出特定的选择，而是帮助患者做出符合患者价值观的选择。可以使用 MI 的一些元素来提高姑息治疗对话的质量和效果。
