Background and Context:
Modern medicine continues to make great strides in delaying the inevitability of death. Dealing with end of life (EOL) issues can be stressful for the health care providers.
Communication is the cornerstone of palliative care. Without clear, goal directed communication palliative care losses it purpose. Unfortunately, many patients may have difficulty in accepting the gravity and import of the palliative care consultation. This can result in a lack of focus, and more critically, the inability to achieve appropriate goals.
There is a wealth of data on delivering bad news to patients and families about a life-limiting diagnosis1-39. This data has been developed in a wide variety of disciplines that includes medicine and psychology. There is separate body of knowledge about talking with the patient that is at end or life or dying
Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT) are validated methods of therapy that can help a patient overcome resistance to acknowledging a difficult truth, and acting on that truth. The Cochrane database indicates that MI may be beneficial in changing behaviors102 Implementing didactic and role-playing strategies for teaching medical students, residents and oncology fellows can improve clinician's communications and outcomes
MI and CBT have a fundamental acceptance and utilization of distress including resistance and denial that promotes the acceptance of the offered therapeutic intervention.10 Rather than confronting the resistance this distress can be used to improve their status or at least to change their perceptions, attitudes and behaviors103
Outcomes/What was learned:Motivational Interviewing and Cognitive Behavioral Therapy are empirically validated methods of therapy. Having the ability to implement the most rudimentary techniques of MI and Cognitive Behavioral Therapy can facilitate conversations of the most difficult type and generate positive change in patients and families