Everyday use of patient-centred, motivational techniques in routine consultations between doctors and patients with diabetes

Objective: Facilitating lifestyle change and improved self-management are important aspects of diabetes treatment. Previous research Shows motivational, patient-centred approaches are more effective at this than traditional, didactic approaches. This study explores the degree to which doctors with no previous training in motivational techniques employ these methods to affect behaviour change in routine consultations. Methods: A cross-sectional design was employed. forty-four routine consultations with nine physicians were tape-recorded, of which nineteen focussed on behaviour change; patient questionnaires assessed patient demographics, intention to self-manage and satisfaction with consultation. Physician behaviour was coded for use of motivational, behaviour change techniques, patient-centeredness and other verbal communication variables; patient communication was also assessed. Results: Lifestyle issues were raised in 43% of consultations but few motivational strategies were employed: 10% of physicians' communication was patient-centred. An association was found between physicians' use of patient-centred strategies and patients expressing views (r = .44, p < .05). Higher patient satisfaction with the consultation was related to physician partnership-building (r = .37, p <= .05) and patients asking questions (r = .3 1, p <= .05). Familiarity between doctor and patient was associated with more physician recommendations and directives (r = .35, p <= .05) and information giving (r = .30, p <= .05), and more assertive responses by the patient (r = .3 1, p <= .05). Conclusion: Effective communication strategies related to behaviour change were not used routinely in diabetes consultaions in the clinic studied. More patien-centred approaches were associated with higher indicators of patient satisfaction. Practice implications: Physicians require training and support in employing behaviour change techniques if these are to be integrated into routine care. (C) 2008 Elsevier Ireland Ltd. All rights reserved.