I94. Understanding Behaviour Change: The Role of Motivational Interviewing (original) (raw)
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Health, 2020
Providing self-management support as a way of meeting the challenge of the predicted rise in long term conditions (LTCs) has been a UK policy agenda for over a decade (Ong et al. 2014b) and continues to underpin person centred NHS supported patient led care for those with LTCs (NHS England 2014). Osteoarthritis (OA) is one such LTC which is reported to lead to discomfort and disruption to individuals as well as costing state and society in terms of lost productivity and healthcare costs (Arthritis Care 2012, Dziedzic et al. 2018). Supported self-management is recommended as a way of ameliorating these problems and helping patients live with OA (NICE 2014). In response a trial intervention featuring primarily nurse-led supported self-management in general practice settings was devised and implemented (Dziedzic et al. 2018), which we detail further below. The efficacy of primary care self-management interventions has been questioned due to clinical trials demonstrating little to no effect (Sun & Guyatt 2013). A longstanding hierarchy of evidence positions trial findings as the 'gold standard' (Barton 2000) and, in part, underpins this debate. The philosophical standpoint of trial methodology emphasises identifying linear causality within a closed system between intervention and outcome (Marchal et al. 2013). It is recognised that embedding self-management support in everyday practice is not straightforward because it requires change at different levels and places additional pressures on practitioners and patients. For professionals it can conflict with external drivers, the existing organization of care, and individual ways of working (Kennedy et al 2013, Ong et al 2014a). Practitioners often experience difficulties reconciling their professional identities and relinquishing responsibilities for patients (Blakeman et al. 2006, McDonald et al. 2008).
Nurse-led Care and Patients as Partners Are Essential Aspects of the Future of Rheumatology Care
The Journal of Rheumatology, 2017
Living with chronic inflammatory arthritis (CIA), such as rheumatoid arthritis (RA) or spondyloarthritis (SpA), affects not only patients' physical functioning but also emotional, psychological, and social aspects that have a global effect on their life situation as a whole 1. The multidisciplinary team is important for the rheumatology care of patients with CIA, which should be delivered with an awareness of the patients' whole life situation. The team should enable these patients to care for themselves and retain or regain optimum independence. The various professional categories in the team have distinct roles but collaborate to focus on the patients' resources and needs 2. Recommendations for rheumatology nursing management of CIA from the European League Against Rheumatism state that rheumatology nurses should participate in comprehensive disease management to control disease activity, as well as in identifying, assessing, and addressing psychosocial issues. This work is a valuable complement to the medical care and helps lower healthcare costs. For patients to achieve a greater sense of control, self-efficacy and empowerment, the nurse should meet the patient's expressed needs and promote self-management skills 3. Rheumatology research has completely changed the therapeutic arena over the past 2 decades, generating the development of the biological disease-modifying antirheumatic drugs (bDMARD) for a greater number of indications 4. Despite this advance, research on nurse-led rheumatology care (NLC) has predominantly focused on patients with RA and conventional DMARD. A systematic review, including 4 randomized controlled trials (RCT) from 1994 to 2006, revealed in a metaanalysis (n = 431) that NLC compared to rheumatologist-led care (RLC) added value by improving patients' perceived quality of life and knowledge, and lessening fatigue. While patient-reported outcomes such as functional status, satisfaction, pain, stiffness, and coping with arthritis favored NLC, there was insufficient evidence to draw conclusions 5 .
Motivational interviewing: relevance in the treatment of rheumatoid arthritis?
Rheumatology, 2015
Advances in pharmacological treatment options in RA have led to a dramatic potential for improvement in patients' physical and psychological status. Despite advances, poor outcomes, including fatigue, pain, reduced physical activity and quality of life, are still observed. Reasons include non-adherence to medication, insufficient knowledge about the disease and lack of support in coping and effectively self-managing their condition. Motivational interviewing (MI) is a person-centred approach that relies on collaboration and empathy aiming to elicit a person's own motivation for behaviour change. It has been implemented in a variety of long-term conditions, addressing issues such as lifestyle changes with beneficial effects, but it is yet to be widely recognized and adopted in the field of rheumatology. This review will explain the techniques underpinning MI and the rationale for adopting this approach in rheumatology with the aim to increase medication adherence and physical activity and improve patients' coping strategies for pain and fatigue.
Patient education and self-management programs in arthritis
The Medical journal of Australia, 2004
Arthritis self-management programs (ASMPs) are integrated into many clinical practice guidelines and policies, and are the core business of Arthritis Foundations. Australian Arthritis Foundations are embarking on a National Quality Assurance Program which should raise awareness and improve confidence in such programs. ASMPs aim to empower people, improve quality of life while living with chronic disease, increase healthy activities and improve self-monitoring - each of which can assist with clinical management, but can be difficult to evaluate. Although there is modest high-quality evidence of traditional "clinical outcomes" from ASMPs, these programs are strongly endorsed by consumers, are being used as a vehicle for healthcare reform, and have the potential to substantially improve public health. Coordinated national delivery of patient education programs has the potential to improve healthcare and outcomes for people with arthritis.
Patients’ confidence in coping with arthritis after nurse-led education; a qualitative study
BMC Nursing, 2016
Background: The aim of this study was to explore how patients with chronic inflammatory polyarthritis described coping with their disease after a nurse-led patient education program and compare these experiences to patients in a control group who did not receive any education. Methods: This was a qualitative study nested within a randomized controlled trial (RCT) investigating the effect of nurse-led patient education for patients with chronic inflammatory polyarthritis. Twenty-six individual face-to-face interviews, 15 in the intervention group and 11 in the control group were conducted approximately two months after the educational program. The same opening question; «Can you please tell me how you have been these last four months, since last time we spoke», followed by questions about the informants' experiences of coping with disease-related challenges, disease activity changes, coping with disease activity changes, the informants' perceptions of good and challenging situations to be in were asked to all informants.
Musculoskeletal Care, 2019
Introduction: A recent survey showed that 27% of rheumatoid arthritis (RA) patients had inadequately controlled disease activity. Hence, there is a need for new strategies aiming at improving patient outcomes. The aim of the present study was to evaluate the effect of a nurse-led clinic with frequent visits, treat-to-target and person-centred care of patients with established RA and moderate-to-high disease activity compared with patients receiving regular care. Methods: The study was a randomized, controlled trial over 26 weeks, with a nonrandomized extension to week 50. Patients were randomized to an intervention group (IG; nurse-led clinic) based on person-centred care, frequent visits and "treat to target", or to a control group (CG) which visited the clinic according to care as usual. The primary outcome was the difference in the DAS28 change between the IG and the CG groups. Results: A total of 332 patients were screened for eligibility, of which 70 were randomly assigned to either the IG (n = 36) or the CG (n = 34) group. The primary outcome was not met, although patients in the IG group tended to improve more than those in the CG group (difference: 0.43 (95% confidence interval [CI]-0.27, 1.13). In both the IG and CG groups, delta-DAS28 improved significantly. The European League Against Rheumatology moderate or good response was achieved by 76% (95% CI 58, 89) in the IG and 49% (95% CI 32, 65) in the CG group. Conclusions: Disease activity tended to improve more with the nurse-led intervention compared with regular care, although the difference was not significant, probably partly due to the lack of statistical power.