Provider updates

It’s common to ask patients these questions: Do you brush your teeth?  Do you floss?  Do you smoke?

There is a distinct pattern with this type of questioning.  While these questions may give us a direct answer, they don’t readily allow for engaged discussion and behavior change.  They are close-ended questions that can easily be answered with a yes, no, or a number. 

Motivational Interviewing (MI) is a fairly new concept in the dental field. MI is a technique in which the health care professional asks Open-ended questions, provides Affirmations and Reflective statements, and Summarizes back to the patient.  This technique is referred to as the OARS.  The goal of the OARS is to elicit behavior change by having the patient arrive at the desired outcome on their own.  This approach decreases resistance to the change while increasing the patient’s own personal motivation.

Using tobacco cessation as the scenario, let’s role play typical questioning vs MI.

Do you smoke? Yes.

How much do you smoke a day? About half a pack.

Are you interested in quitting? Not really.

Ok, you really should think about quitting.

It’s difficult to move forward with tobacco cessation from these responses.  How could we engage the patient by using MI techniques? Let’s use an open-ended question.

Do you smoke? Yes.

How much do you smoke a day?  About half a pack

What’s keeping you from quitting?  I don’t know.  I know it’s bad for me.  I don’t even smoke in front of my kids.

Affirmations verify the patient’s strengths or efforts, and helps with relationship building.  When providing an affirmation, back it up with a specific point so that it’s more than a compliment.

 You really care about your kids.  You don’t want them to see you with the cigarette so you don’t smoke in front of them.  Yeah.  I don’t like doing something I have to hide from them.

Reflections are exactly that; the provider reflects the patient’s own words back to them.

It sounds like you don’t like doing something you have to hide from your kids.   I actually really don’t like smoking.  I wish I could quit. How do you feel about calling the QuitLine today?  I can do that.  On a scale of 1-10, how sure are you that you’ll call the QuitLine?  I think I’m at an 8.

The Summary captures what’s been said.

So far you’ve told me that you’re concerned about your kids and you’re interested in quitting. You feel like you can call the QuitLine, and you’re at an 8 out of 10 for calling and getting more info.  Anything else?

MI allows providers to identify “change talk”, or indicators that a person is ready to make a behavior change.  Using the DARN CAT acronym, providers can be on the lookout for change talk- or hearing from the patient a Desire, Ability, Reason, or Need to change, or evidence of a change already happening through Commitment, Activation, or Taking Steps towards a change. 

The MI conversation has a different pace than our typical dental visit interactions.  The clinician displays empathy and reflective listening skills, with pauses, to allow the patient time to think and feel safe enough to be vulnerable.  Like anything else, MI becomes easier with practice. You are the facilitator that helps guide the patient as they explore how they can make a positive change.   For more info on MI or a schedule of local trainings, check out these websites:   MINT (Motivational Interviewing Network of Trainers), ATTC (Addiction Technology Transfer Center Network), and PCC (Portland Community College).