Laws Michael Barton, Rose Gary S, Beach Mary Catherine, Lee Yoojin, Rogers William S, Velasco Alyssa Bianca, Wilson Ira B
Dept of Health Services, Policy and Practice, Brown University School of Public Health, Providence, USA.
Massachusetts School of Professional Psychology, Boston, USA.
Patient Educ Couns. 2015 Jun;98(6):728-33. doi: 10.1016/j.pec.2015.02.014. Epub 2015 Feb 23.
Motivational Interviewing (MI) consistent talk by a counselor is thought to produce "change talk" in clients. However, it is possible that client resistance to behavior change can produce MI inconsistent counselor behavior.
We applied a coding scheme which identifies all of the behavioral counseling about a given issue during a visit ("episodes"), assesses patient concordance with the behavioral goal, and labels providers' counseling style as facilitative or directive, to a corpus of routine outpatient visits by people with HIV. Using a different data set of comparable encounters, we applied the concepts of episode and concordance, and coded using the Motivational Interviewing Treatment Integrity system.
Patient concordance/discordance was not observed to change during any episode. Provider directiveness was strongly associated with patient discordance in the first study, and MI inconsistency was strongly associated with discordance in the second.
Observations that MI-consistent behavior by medical providers is associated with patient change talk or outcomes should be evaluated cautiously, as patient resistance may provoke MI-inconsistency.
Counseling episodes in routine medical visits are typically too brief for client talk to evolve toward change. Providers with limited training may have particular difficulty maintaining MI consistency with resistant clients.
人们认为咨询者采用动机性访谈（MI）一致的谈话方式能够促使来访者产生“改变谈话”。然而，来访者对行为改变的抵触可能导致咨询者出现与MI不一致的行为。
我们运用了一种编码方案，该方案可识别就诊期间针对特定问题的所有行为咨询（“片段”），评估患者与行为目标的一致性，并将提供者的咨询风格标记为促进性或指导性，应用于一组HIV感染者的常规门诊就诊记录。我们使用另一组可比诊疗的不同数据集，应用片段和一致性的概念，并使用动机性访谈治疗完整性系统进行编码。
在任何片段中均未观察到患者的一致性/不一致性发生变化。在第一项研究中，提供者的指导性与患者的不一致性密切相关，在第二项研究中，MI不一致性与不一致性密切相关。
鉴于患者的抵触可能引发MI不一致，对于医疗提供者的MI一致行为与患者改变谈话或结果相关的观察结果应谨慎评估。
常规医疗就诊中的咨询片段通常过于简短，以至于来访者的谈话难以朝着改变的方向发展。培训有限的提供者在与抵触的患者保持MI一致性方面可能会特别困难。
