Review Question - QID 217703

This patient who relapsed on alcohol should be encouraged with the use of motivational interviewing techniques. "Help me understand why you feel afraid?" is the most appropriate response because it is an open-ended question.

The OARS principles are a set of foundational ideas for how to most effectively motivate patients to change their behaviors during the medical interview. The O stands for open-ended questions, which are questions that invite the patient to elaborate on their emotions rather than forcing a specific set of responses such as "yes" or "no". The A stands for affirmations, which are designed to support and acknowledge the strengths of the patient. The R stands for reflective listening, which are statements that repeat or paraphrase the patient's answers in order to encourage them to elaborate more fully on the response. Finally, the S stands for summaries, which are statements that capture and consolidate the information the patient has provided thus far in the interview. Together, these principles allow for effective motivational interviewing.

Lundahl et al. studied the principles taught for performing motivational interviewing. They find that there is significant variability in techniques; however, some of the most common include OARS and evoking motivation for change.

Incorrect Answers:
Answer 1: Are you interested in joining Alcoholics Anonymous again? This is not the most appropriate response because it is a close-ended question that does not allow the patient to elaborate further. It may be the correct treatment choice, but this is too early in the interview to decide on that course of action.

Answer 2: Do you understand the negative effects of continuing to drink? This is not the most appropriate response because it is close-ended and can be interpreted as being judgmental. Patients are unlikely to be forthcoming when confronted with a response such as this one.

Answer 4: Is it alright if I speak with your wife about her perspective as well? This is not the most appropriate response because the clinician has not yet fully explored the topic with the patient. It is clear that this patient values the opinions of his wife and she may be a great source of collateral later in the conversation; however, it is not appropriate to ask to speak with her prior to discussing the issue fully with the patient.

Answer 5: Would you be interested in starting a medication to help with sobriety? This is not the most appropriate response because it is a close-ended question that offers a solution before elucidating the topic with the patient. In motivational interviewing, open-ended questions should precede close-ended questions in order to allow the patient to share their perspective.

Bullet Summary:
Open-ended questions, affirmations, reflective listening, and summaries are core principles of motivational interviewing.