Shared Decision Making and Motivational Interviewing: Achieving Patient-Centered Care Across the Spectrum of Health Care Problems

The Article in Brief

Glyn Elwyn , and colleagues

Background Different clinical situations require different communications approaches. Clinicians must be able to determine appropriate communication methods and, when necessary, integrate them. This report explores two communication approaches--shared decision making and motivational interviewing--and the application of these methods across a range of clinical problems.

What This Study Found In shared decision making, the clinicians' role is to help patients understand reasonable options and then elicit, inform and integrate patients' informed preferences. This method is effective when patients face difficult treatment decisions. Motivational interviewing is most often applied when a patient feels ambivalent about necessary behavior change, such as lifestyle choices or adherence to medications. Using motivational interviewing, clinicians can help patients identify and resolve ambivalence by exploring their personal perspectives and perceived barriers. Although these methods have been considered distinct and non-overlapping, practitioners may benefit from drawing on both approaches to provide patient-centered care in real-world clinical situations when behavior change and choosing between competing options are relevant.

Implications

• There are considerable challenges in implementing shared decision making and motivational interviewing into routine practice. Nonetheless, the authors posit that there will be little progress in patient-centered care until these methods are valued as core elements of good practice. This will require that they are taught, assessed, and integrated into practice, and appropriately measured and rewarded.