Question
How can I elicit change talk in a patient?
Answer
Let's discuss some of the ways that we might engage a patient in change talk. Behavior change is not just education; it is actually motivation and willingness to engage in change.
Eliciting change talk is one way to engage someone to change their behaviors. The "Motivational interviewing" by William R. Miller and Stephen Rollnick is a great resource. I recommend you read it - you don't need to be a psychologist or a therapist to benefit from the information.
In the book is an idea to ask a patient to rate themselves where they are, on a scale of one to 10. We think that most patients have some sort of ambivalence about behavior change. They may not be 100% on board with change or against it, and maybe they can articulate and explain a couple of reasons why they might go either way.
For example, say a patient needs to undergo a certain procedure, and they're resistant towards it. I can use scaling by saying, "If 1 = I will never have that procedure, absolutely not, and a 10 = Yes, I want that procedure right now, where are you on that scale?" The patient's answer will give you a sense of where that patient is with their decision. They may tell you that they're at 3, and say something like, "You know I really don't want to move forward with this new surgery, I'm at 3." I can then pause, and ask some questions. I can ask them why they are at 3 and not at 1. If I say something like that, then the patient or caregiver can explain and detail the reasons why they're not lower. In other words, they have to argue for the change (from 1 to 3). True behavior change comes from increasing motivation and getting a patient themselves, talking about the reason of why they want to engage in a change. If they say, "Well I'm a 3 and not a 1 because I know this would probably be really helpful for me, and make my breathing easier most likely." Now you're getting that patient discussing reasons for change.
You can also get them to discuss reasons for change by asking them, "What makes you think you need to change?" With teens, one of my favorite questions to ask is "Why do you think your caregiver wants you to do this? What do you think they would say if we asked them?" Again, it gets the person talking about the reasons for change. Then you can ask if they agree with the caregiver.
You can also ask what the patient thinks will happen if they don't change. Ask them what would happen if they don't go through with the procedure. They may list things like they could be re-admitted, or might not be discharged. Get the patient to talk about the reasons that they do not want to maintain their current challenges.
Another question you can ask to elicit change behavior is, "Do you think others are concerned about your behaviors, and why?" I use the example of caregivers, but it could really be anyone.
Finally, you could have this conversation from the other direction. If the patient says they are a 3, ask what it would take to move them to a 7, for example. Ask what barriers there are to move them to a 7 and what you can do to help them. This gets them talking about what else needs to happen or what else needs to change to get their motivation to increase over time.
This has been a quick recap of motivational interviewing and change talk, but it's definitely worthwhile to think about and read about. The whole idea is to get on the side of your patient, roll with the resistance, and get them talking more about the reasons that they want to engage in a change, rather than not.
