motivational interviewing · the case for motivational interviewing in the management of diabetes...
TRANSCRIPT
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The case for
Motivational InterviewingIn the management of diabetes
foot ulcers
Dr. Sarah Jarvis
TUES 29 October 14.00–14.45Main Theatre Olympia
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WelcomeDr. Sarah Jarvis
Motivational Interviewing
vs
Scare Tactics
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Motivational Interviewing
vs
Scare Tactics
Dr. Sarah Jarvis
The case AGAINST
Motivational Interviewing
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WitnessProf Paul Chadwick
Visiting Professor
Birmingham University
4
Motivational Interviewing
vs
Scare Tactics
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Prof Paul Chadwick
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Risk Stratification
60%
20%
15%
5%
20% Increased riskRegular ‘foot protection’
5% Active ulcers or infectionRevascularisation or amputation
Multidisciplinary foot care team management
60% Low riskRoutine annual screening
15% High risk
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programme
Ivory tower / real world
Is it the profession or the patient?
Evidence
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Academia
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Not Fake News
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Real World
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DFU Risk Awareness Pilot Results
9%
87%
4%
PatientsDo you want us to continue to use the poster
and leaflet campaign with patients (T=55)
No
Yes
Abs
14%
72%
14%
CliniciansDo you want to continue to use the poster and leaflet campaign with patients (T=29)
No
Yes
Abs
(Fox & Smith, 2018)
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Informing & negotiating change
X
XX
X
?
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Latest evidence?
o Robust evidence for DFD-prevention is lacking (Binning et al. 2018)
o There remains a research GAP!
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Back in the day
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They made conclusions
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Dr. Sarah Jarvis
Motivational Interviewing
vs
Scare Tactics
The case FOR
Motivational Interviewing
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WitnessProf Karen Ousey
Professor of Skin IntegrityUniversity of Huddersfield
18
Motivational Interviewing
vs
Scare Tactics
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The Case FOR Motivational Interviewing
Dr. Karen Ousey
Professor of Skin Integrity
University of Huddersfield
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Scare Tactics vs. Motivation
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Time
• People with diabetes spend around 3 hours with a healthcare professional every year
• The remaining 8,757 hours is self managed
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Facts – Diabetes
In one year the diabetes transformation fund has led to an extra:
• 96 inpatient specialist nurses and related staff in inpatient teams
• 94,000 places on education courses being available
• DAFNE, X-PERT & DESMOND educational programmes
• 185 staff appointed to foot care teams across 80 hospitals
• Putting Feet First campaign
DUK:
• UK’s first ever diabetic foot clinic in 1981 at King’s College Hospital
• After three years the number of major amputations had halved
• Mental health & emotional support –reducing ‘diabetes burnout’
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Motivational Interviewing
What is it?
• Solution focused - Patient centred
• Based on:
➢ How we speak to people
➢ Listening and understanding
➢ The person who has the problem has the answer to
solving it
➢ People only change their behaviour when they feel
ready - not when they are told to do so
➢ Solutions - person centred are the most enduring
and effective
Process
• Engaging – understanding the patient's point of
view
• Focusing - developing one or more clear goals for
change
• Evoking - patient’s own motivation for, and ideas
about, change
• Planning - collaborative development of the next
steps that the individual is willing to take
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RULE
R Resist the urge to change the individual’s course of action through didactic means
UUnderstand it’s the individual’s reasons for change, not those of the practitioner, that will elicit a change in behaviour
L Listening is important; the solutions lie within the individual, not the practitioner
E Empower the individual to understand that they have the ability to change their behaviour2
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Supporting Change2
• Precontemplation: • The patient does not believe there is a problem – e.g. I will
not get a DFU
• Contemplation:• Problem is recognised – e.g. maybe I will get a DFU
• Action• Takes preventative action e.g. off loading
• MaintenanceI will wear the correct footwear
• Relapse• Returns to undesired behaviours e.g. the weather is nice I am
wearing no shoes
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Motivational Interviewing – Agenda Setting
• Patient is in charge
• Improves patient confidence
• Encourages self management
Menu of diabetes topics
YOUR MEDICATIONS YOUR FOOD
YOUR EXERCISEYOUR BLOOD SUGAR
MONITORING
Please pick one topic for discussion today
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Education
• Stop commencing lectures with...
• People who have diabetes are 15 times more likely to undergo amputations than other people without the condition
• One amputation every hour, 24 per day and 169 per week take place due to complications from diabetes
• We must link mental and physical health together for HCPs
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Scare Tactics vs. MI
• MI is the way forward!
• The effective management of diabetes requires a
lot of behaviour change for most patients
• People tend to be ambivalent about change
• Health professionals often resort to the “righting
reflex” and overly rely on a directing style
• When someone advocates for change with a
person who is ambivalent about it, a natural
response is to defend the other side
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References
• Prochaska, J.O. & DiClemente, C.C. (1986). Toward a comprehensive model of change. In W. Miller and N. Heather (Eds.), Addictive behaviors: Processes of Change. New York: Plenum Press, pp. 3-28.
• S Rollnick, WR Miller and CC Butler. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, New York: The Guilford Press. 2008. 210
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Motivational Interviewing
vs
Scare Tactics
Dr. Sarah Jarvis
The case AGAINST
Motivational Interviewing
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WitnessDonna Welch
Principal Podiatrist Diabetes
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WitnessDonna Welch
Principal Podiatrist Diabetes
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Dr. Sarah Jarvis
Motivational Interviewing
vs
Scare Tactics
The case FOR
Motivational Interviewing
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WitnessSue Marshall
Editor of Desang magazine
35
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vs
Scare Tactics
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Sue Marshall
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Why?
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How?
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The case for
Motivational
InterviewingIn the management of diabetes foot ulcers
Dr. Sarah Jarvis
Final
Judgement