Welcome to our SCCM Leadership, Empowerment, and Development Micro-Learning Session today, LEAD for short. I am Jerome Lee, a critical care and emergency physician at Mass General in Boston. Today I have the pleasure of introducing our speaker, who's going to talk to us about an evidence-based framework on how to talk to our patients about hesitancy with the COVID-19 vaccine. I know I have, and I'm sure many of you continue to receive questions about the COVID-19 vaccine. Not only from patients and families, but also, unfortunately, close friends, colleagues, and also family. These are very difficult conversations, especially what we've been and seen over the last 18 months. Personally, I find it frustrating because there is a way out of this pandemic, but many are choosing not to take it. My initial response is to try to convince them aggressively by using science and facts. Unfortunately, this usually falls short and fails most of the time. There is a better and more effective way. In the next 10 minutes, our speaker is going to introduce us to a new concept or old concept and framework that is well-known to our social workers that help with these difficult conversations. It's called motivational interviewing, or MI for short. MI is evidence-based, well-studied, and battle-tested over the years. It has been shown to reduce recidivism among patients with trauma, substance use disorder, and many other populations. Today I am pleased to introduce our speaker and expert in motivational interviewing, Mary Susan Covery. Mary Susan is a clinical specialist in the Department of Social Work at Mass General Hospital in Boston. She is one of our master educators and expert clinical faculty. In the next few minutes, she will teach us about motivational interviewing and how to use it. Thank you again for joining us, Mary Susan. During the COVID-19 pandemic, healthcare providers often encounter patients that have ambivalent or fearful reactions as to whether they should get a COVID-19 vaccination. This can be frustrating for providers who believe that if you lead with the facts and tell people what to do, that this will result in patients doing what the provider tells them to do. In other words, doctor's orders. Such behavioral reactions are certainly seen in other healthcare issues and other behavioral problems, such as substance use, overeating, medication adherence, and smoking, to name a few. There are many factors that contribute to the resistant reactions to the COVID-19 vaccines, and the provider is often left with questions about how to best engage in conversations with patients who express hesitancy in wanting to be vaccinated, even as they express a desire to not become infected. One set of skills that research has demonstrated is useful in engaging patients in behavioral change is motivational interviewing. So what is motivational interviewing? MI is an evidence-based intervention that shifts the provider's approach to interacting with patients. Instead of pressing, pleading, directing, or demanding patients to change their ways, providers briefly connect or come alongside the patient and help them make the change or decisions for themselves. Research has shown it to be effective in changing behaviors while working toward building or preserving trust in the caregiver relationship. So who developed motivational interviewing? MI was developed in part by clinical psychologists William Miller and Stephen Rolnick. It was created as a means to push past resistance to change, whether behavioral, psychological, or medical. This was based on the Carl Rogers person-centered theory that people are capable of autonomous change. Why is MI helpful? Health care providers are trained to provide answers and direction regarding multiple medical needs. It is common to feel the urge to tell someone what to do. And indeed, some patients seek this consultation and advice and will follow through as directed. But many people, maybe even most people, resist being told what to do. It might appear that simply telling a patient what to do is the most effective and efficient way to improve health behaviors, but this all too often falls on deaf ears. Or even worse, it can lead to kickback or resistance. Saying I would like to advise you to is met by the patient with a blank look or yes, but I can't is the response. What can result is a tug and pull between patient and provider that can end with feelings of frustration or even anger. So where is motivational interviewing applicable? MI is useful in health care and counseling and is often used with patients who are reluctant, unwilling, or not ready for behavior changes that are needed to improve health outcomes. For example, like dietary changes, suggestions for increased exercise, or smoking cessation. And certainly in this current COVID-19 pandemic, there is vaccination hesitation. So how is motivational interviewing done? A useful mnemonic for remembering the techniques of motivational interviewing is the word ORS, O-A-R-S, O, open-ended questions, A, affirmation and statements, R, reflective listening, and S, summarizing. Open-ended questions allow patients to give more information, including their feelings, attitudes, and understanding. Affirmations help overcome self-sabotaging thoughts and statements, negative thoughts, and other types of resistance. Reflections are a way for patients to express ambivalence. And S is summarizing to let your patient know that they are being heard. Here are some examples of statements using the ORS principles. A statement using open-ended questions can be, I would like to talk with you about COVID-19 and your health. What are some of your thoughts and questions about the COVID-19 vaccines? What if any are your biggest concerns? A sample of an affirmation. It's apparent that the health and well-being of your family and friends is very important to you, and you try to stay informed. A reflection could be, I hear you saying that you have been talking with friends and family and have read some articles about the COVID-19 vaccines. It matters to you to get accurate information from trusted sources. An example of summarizing could be, I hear that you are worried about the possibility of getting COVID-19 or spreading it to family, elders, and children. It's important to you to get accurate information from trusted sources. It's true that there is a lot of conflicting information being shared by friends, family, and the media. I would like to offer you information that can help answer your questions. Often one question can lead to another, and I am committed to providing you with the best care and information that supports your health and well-being. These sample comments are only a few examples of how to utilize the OARS principles. The goal is to use the concepts with your own personality and workflow. The purpose is to engage the patient, understand their underlying concerns, and strengthen the trusted alliance between provider and patient. If patients see their providers as such, they are more likely to trust, they are more likely to act on the advice and expertise of the provider as they see it in their best interest. Motivational interviewing cannot guarantee behavior change, but research has demonstrated that it can increase the possibility of change, and this is something all health professionals can utilize with the goal of better health outcomes, and importantly, building trusted relationships with their patients.

motivational interviewing

healthcare providers

COVID-19 vaccine

evidence-based intervention

patient-provider alliance