Feasibility of using communication coaching to teach palliative care clinicians Motivational Interviewing

Abstract Context Palliative care clinicians often have challenging conversations with patients or family caregivers who express ambivalence about goals or feel reluctant to discuss topics. Motivational Interviewing (MI) has tools to address ambivalence and reluctance. The aim of this pilot was to test the feasibility, acceptability, and preliminary efficacy of an MI communication coaching intervention. Methods We enrolled 22 palliative care clinicians and randomly assigned half to receive communication coaching vs. waitlist control. The coaching entailed: a lecture on MI, a 1:1 session to discuss applying MI, and audio recording and receiving feedback on four encounters (2 separate times). Palliative care clinicians in the waitlist control arm audio recorded four encounters. Coders blinded to study arm coded MI behaviors. We surveyed patients, caregivers, and clinicians after all audio recorded encounters to assess perceptions of the encounter. The analyses were performed using a repeated-measures mixed model. Results We found the intervention to be feasible and acceptable. 86% of those enrolled completed all study activities including coaching sessions, audio recording encounters, and completing surveys. Of those in the intervention arm, 88% rated the intervention as helpful and 100% would recommend it to a colleague. Compared to control clinicians, intervention clinicians had higher ratings of their MI skills post-intervention, higher objectively rated communication skills, and slightly better burnout scores. We found no arm differences in patient, caregiver, or clinician ratings of satisfaction. Conclusion This pilot indicates that coaching palliative care clinicians is feasible and shows promise that coaching can improve palliative care clinician communication.