An international Delphi consensus study to define motivational communication in the context of developing a training program for physicians

Abstract

Poor health behaviors (e.g., smoking, poor diet, and physical inactivity) are major risk factors for noncommunicable chronic diseases (NCDs). Evidence supporting traditional advice-giving approaches to promote behavior change is weak or short lived. Training physicians to improve their behavior change counseling/communication skills is important, yet the evidence for the efficacy and acceptability of existing training programs is lacking and there is little consensus on the core competencies that physicians should master in the context of NCD management. The purpose of this study is to generate an acceptable, evidence-based, stakeholder-informed list of the core communication competencies that physicians should master in the context of NCD management. Using a modified Delphi process for consensus achievement, international behavior change experts, physicians, and allied health care professionals completed four phases of research, including eight rounds of online surveys and in-person meetings over 2 years (n = 13–17 participated in Phases I, III, and IV and n = 39–46 in Phase II). Eleven core communication competencies were identified: reflective listening, expressing empathy, demonstrating acceptance, tolerance, and respect, responding to resistance, (not) negatively judging or blaming, (not) expressing hostility or impatience, eliciting “change-talk”/evocation, (not) being argumentative or confrontational, setting goals, being collaborative, and providing information neutrally. These competencies were used to define a unified approach for conducting behavior change counseling in medical settings: Motivational Communication. The results may be used to inform and standardize physician training in behavior change counseling and communication skills to reduce morbidity and mortality related to poor health behaviors in the context of NCD prevention and management.

Training Physicians in Motivational Communication to Address Influenza Vaccine Hesitation: A Proof-of-Concept Study

“…In line with the spirit of MC, this highlights the need to shift the traditional 'provider as expert' role to a more collaborative one, especially when the focus of the consultation is patient behavior change. Collaborative goal setting for self-management is critical in the context of changing health behaviors like vaccination [15,26,33]. Building collaborative relationships between patients and healthcare providers is also crucial in the context of the COVID-19 crisis, where vaccine uptake is one of the most import prevention behaviours that people can adopt to curb the pandemic.…”

“…MC is defined as an evidencebased, time-efficient communication style used by health care providers to promote patient engagement, adoption of healthy behaviors and sustained self-management of chronic conditions. It is informed by the behavioral sciences and emphasizes shared decision-making that is tailored to the patient's preferences, goals and values [26]. MC was developed collaboratively with HCPs and behavior change experts using an integrated knowledge translation (iKT) approach where all stakeholders were involved in the development process to optimize acceptability and uptake.…”

Mechanisms associated with increased physical activity in patients undergoing self-management behaviour modification in the randomised PHYSACTO trial

“…It is also proposed that behaviour change techniques should be used to elicit patient motivation, confidence and competence. MC [27] is often used as an evidence-based communication style designed to strengthen a p rson"s autonomous motivation and commitment to change [28]. MC involves establishing a collaborative partnership, evoking motivation/desire to change, strengthening on n to h n n r sp t n th p t nt"s utonom .…”

Elaboration and refinement of a motivational communication training program for healthcare professionals in pediatric oncology: a feasibility and acceptability study

“…The approach of MC is also strongly embedded in the three psychological needs that are the pillars of SDT: the needs for competence, social relationships, and autonomy. In MC, change is highly facilitated when the individual feels able to act in a specific environment (competence), when she/he feels connected with the interventionist (social relationships), and when he/she feels being at the origin of her/his behavior (Deci & Ryan, 2012 ; Dragomir et al, 2020 ). MC is designed to emphasize the autonomy of the patient by favoring a respectful and constructive relationship with the professional (Laurin & Lavoie, 2011 ).…”